Radiology Coding Alert

Question: In a patient who had improper functioning of morphine infusion pump, our physician made an interpretation of extravasation of contrast adjacent to the pump. There was no contrast extending into the tubing when our physician did the morphine pump injection under sterile conditions and utilizing fluoroscopic guidance. 

The procedure note read the following: “A 22-gauge needle was advanced into the entry port at the apex of the patient’s infusion pump. Contrast of 20 cc of Optiray 300 was injected under fluoroscopic guidance. Contrast was noted to be extravasating adjacent to the pump and there was definitely no contrast extending into the pump tubing.”

How can we report this procedure?

Michigan Subscriber

Answer: Your physician is doing an “implanted infusion pump study” also known as “pump-o-gram” to verify catheter patency and pump function. It is appropriate for you to report code 75809 (Shuntogram for investigation of previously placed indwelling nonvascular shunt [e.g., LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump], radiological supervision and interpretation) for the radiologic supervision and interpretation (RSI) portion of the procedure to evaluate for shunt catheter patency or leakage. You can report this code for evaluation of a variety of similar and related nonvascular shunt catheters and devices that require the injection of contrast. 

Occasionally, your physician will evaluate for discontinuity using plain radiography or CT imaging, without catheter contrast injection. In such cases, you report the service using appropriate radiography or CT codes describing which anatomical areas were imaged (e.g., brain, neck, chest, and/or abdomen).

Implanted pump catheter dye studies typically require an injection component and an RSI component; therefore, confirm what exactly your physician does. It would also be appropriate for the physician performing the injection to report code 61070 (Puncture of shunt tubing or reservoir for aspiration or injection procedure) to describe the injection service itself.

You report code 61070 and 75809, each with 1 unit of service. If your physician performs this in a facility place of service, you append modifier 26 (Professional component) to the 75809 radiology code.