Neurosurgery Coding Alert

When reporting refills for baclofen, use 95990/95991

When reporting drug refills of baclofen for an implantable pump or reservoir, you should stay away from 96530 and choose instead 95990 or 95991.
 
Our article "Drug and Pump Are Separate for Baclofen" in the August 2004 issue (page 62) incorrectly stated that you should use 96530 (Refilling and maintenance of implantable pump or reservoir) to report filling of implantable pain pump. "Our reimbursement group specifies that physicians should report 96530 for refilling of cancer drugs. Baclofen doesn't fall into that category," says Franceen Horin, MBA, CPCM, communication and marketing manager for Medtronic Economics.
 
Rather, to report baclofen refill services, select either 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain) or 95991 (... administered by physician).
 
Use 95990 for Nurse-Provided Services: "You should report 95990 if the nurse performs the entire procedure and bill using the physician's provider ID number," Horin says.
 
Under "incident-to" requirements, the physician must be on-site and immediately available during the procedure, says Linda Holtzman, MHA, RHIA, CCS, CCS-P, CPC, CPC-H, a coding expert with Clarity Coding. And, code 95990 is not billable in the hospital outpatient setting. Rather, you must use 95990 only in the physician office setting.  
 
Turn to 95991 for Physician-Provided Services: "In contrast," Horin adds, "you should report 95991 when the refill is 'performed' by an MD." Although assistance by the RN or other extender staff can occur, the physician must personally refill the pump to report 95991, Holtzman says.