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Oncology & Hematology Coding Alert

Take the Sting Out of Intrathecal Therapy

Published on Fri Nov 01, 2002

Implantation and removal of intrathecal pumps for trials and delivery of pain medication require oncology coders to stay alert to differing documentation strategies.

When patients undergoing chemotherapy or radiation cannot tolerate oral, transderma or rectal medication due to the side effects of the opioids, "studies have shown that the us of intrathecal narcotics can yield fewer side effects and complications," says Lynne Carr Columbus, DO, of Gulf Coast Pain Management in Palm Harbor, Fla.

Coding Guidelines for Intrathecal Administration

Intrathecal pain therapy involves the placement of a pain pump directly under the skin. Via an indwelling catheter, the pump directs controlled doses of analgesia directl to the site of action in the spine.

CPT 2002 provides the following codes related to the placement and removal of the catheter and pain pump:

  • 62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy
  • 62351 ... with laminectomy
  • 62355 Removal of previously implanted intrathecal or epidural catheter
  • 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir
  • 62361 ... non-programmable pump
  • 62362 ... programmable pump, including preparation of pump, with or without programming
  • 62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion.

    Catheters and pain pumps are maintained with the following codes:

  • 62367 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming
  • 62368 with reprogramming
  • 96530 Refilling and maintenance of implantable pump or reservoir.

    Documentation and Drug Guidelines Vary by Region

    The local medical review policy for Regence Blue Cross Blue Shield, Utah's Part B Medicare carrier, states that intrathecal pain therapy may be used for the management of chronic intractable pain, particularly that which is secondary to carcinoma (primary or metastatic), when it is not controlled by less invasive techniques. As with all covered procedures, medical necessity must be established and the treatment must match the diagnosis. Regence's coding guidelines state that when the cause of pain is malignancy, the diagnosis code for the malignancy should be used. Among the covered ICD-9 codes listed in the LMRP are 170.2 (Malignant neoplasm of the vertebral column, excluding sacrum and coccyx), 170.3 (Malignant neoplasm of ribs, sternum, and clavicle), and 171.7 (Malignant neoplasm of trunk, unspecified).

    In addition to the CPT codes listed previously, Regence's LMRP also lists two reimbursable drug codes: J2270 (Injection, morphine sulfate, up to 10 mg) and J2271 (Injection, morphine sulfate, 100 mg). "These drugs carry special coverage instructions," says Kelly Dennis CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. Dennis says Florida's Part B Medicare carrier specifies that supplies and drugs that are furnished for an implantable infusion pump must be prescribed by the patient's physician and documented with the initial claim.

    Unique Coding for Intrathecal Trials

    For all intrathecal pumps, a physician certification of life expectancy of three months or more must be noted in the patient's medical record, along with a statement that the patient has been unresponsive to less invasive medical therapy. Patients should also have completed a trial of intrathecal administration.

    "The LMRPs for many contractors state that the trial injection should not be coded under 62350," Dennis says. Rather, coders should use the following, depending on the anatomic site and modality:

  • 62310 Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
  • 62311 ... lumbar, sacral (caudal)
  • 62318 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
  • 62319 lumbar, sacral (caudal).

    Columbus says that the key to cancer pain management is determining which unique therapy or combination of therapies will work for each patient.

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