Neurosurgery Coding Alert

Question: When we have a patient come into the office for reprogramming of a pump implant (62368), would it be appropriate to bill a low level office visit based on reviewing the patient's history, taking the patient's vitals and reviewing any medication changes? We have a case where only the vitals were taken and the reprogramming was done. Normally the doctor will go over any medication changes.

Wisconsin Subscriber

Answer: The answer depends on the purpose of the visit. If the patient has been scheduled for the purpose of reprogramming the pump, there are pre-service E/M activities bundled into the re-programming code, including updating history and examination. However, if the patient has another unrelated problem which prompts an E/M service for the unrelated problem or the patient has been scheduled for the purpose of evaluating a problem and it is determined at the time for the visit that reprogramming of the implant is warranted, then an E/M service with the appropriate modifier can be reported.