Pain Management Coding Alert

Question: We used to bill the 62368, 95991, and the appropriate J code for pump refills. At one point the 62368 became inclusive to the 95991, so we began only submitting 95991 with the J code. I heard recently that there was another code that can be billed with the refills. Do you have any suggestions on what to look for?

Vermont Subscriber

Answer: If the provider is refilling an implantable programmable pump, he should report either 62369 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill) or 62370 (… with reprogramming and refill [requiring skill of a physician or other qualified health care professional]).

Both codes include the analysis, re-programming, and refill services previously reported with 95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular], includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional) and 62368 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming).

Background: The new combination codes 62369 and 62370 were added to CPT® in 2012. Codes 95990 and 95991 were not deleted as they would be used to report refilling an implanted pump that is not programmable (i.e., constant flow or a reservoir). The programmable implanted infusion pump is re-programmed at each refill, so either 62369 or 62370 codes should be reported. Which of these two codes you report is based on who actually performs the services. For a physician or other qualified health care professional, you report 62370; for a clinical staff member, you bill 62369.