Neurosurgery Coding Alert

A noncovered diagnosis can easily result in a speedy denial. ICD-9 codes commonly accepted by Medicare carriers to justify the medical necessity for implantation of a pain pump differ radically from acceptable diagnosis codes for a removal or revision.

1. Implantation. A search of local medical review policies indicates the following ICD-9 codes are commonly accepted by Medicare carriers for the implantation of a pain pump (62360, 62361 or 62362) and catheter (62350-51 or 62351-51):

053.12 Postherpetic trigeminal neuralgia
053.13 Postherpetic polyneuropathy
141.0-208.9 Malignant neoplasms
322.2 Chronic meningitis
333.7 Symptomatic torsion dystonia
334.1 Hereditary spastic paraplegia
335.20 Amyotrophic lateral sclerosis
336.9 Unspecified disease of spinal cord
337.20-337.29 Reflex sympathetic dystrophy
340-341.9 Multiple sclerosis and other demyelinating diseases of central nervous system
343.0-343.9 Infantile cerebral palsy
353.6 Phantom limb pain
354.4 Causalgia of upper limb
354.9 Mononeuritis of upper limb, unspecified
355.71 Causalgia of lower limb
355.9 Mononeuritis of unspecified site
722.52 Degeneration of lumbar or lumbosacral invertebral disc
722.80-722.83 Postlaminectomy syndrome
733.13 Pathologic fracture of vertebrae
854.00-854.19 Intracranial injury of other and unspecified nature

2. Removal or revision. ICD-9 codes commonly accepted for the removal of a pain pump (62365) and catheter (62355-51) or the revision of a pain pump (62360, 62361 or 62362) and catheter (62350-51 or 62351-51) include:

996.00 Mechanical complication of unspecified device, implant, and graft

996.63 Infection and inflammatory reaction due to nervous system device, implant, and graft

996.70 Other complications of internal (biological) (synthetic) prosthetic device due to unspecified device, implant, and graft

Note: Consult your local carriers for a complete list of accepted ICD-9 codes.