Wiki Morphine pump billing question

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kburke

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Can someone who has experience please explain to me how you are billing for a refill of a morphine pump and what codes you use, drug being morphine and what the breakdown is. I am fairly new to coding, but am working for a pain management physician and we just discovered that our refills are being billed incorrectly and have been for years. I need serious help please!

Thanks!

Kristi
 
AMA CPT Changes 2012

62369 with reprogramming and refill

Added 2012


62370 with reprogramming and refill (requiring skill of a physician or other qualified health care professional

Added 2012

Rationale

The AMA/Specialty Society RVS Update Committee (RUC) identified codes 62367, 62368, 95990, and 95991 in the "Codes Reported Together 75% or More" screen. As a result, the services described by these codes have been combined as appropriate by revising code 62367, adding two new codes to this code family, and revising codes 95990 and 95991. See the Medicine/Neurology and Neuromuscular Procedures/Other Procedures section of this book for an explanation of the revisions to codes 95990 and 95991.

Code 62367 has been revised to specify that it does not include refilling of a programmable, implanted pump that is used for intrathecal or epidural drug infusion. Codes 62369 and 62370 were added to this code family to report electronic analysis of a programmable, implanted pump for intrathecal or epidural drug infusion, including reprogramming and refilling of the pump. Code 62369 is reported when a physician's skill is not required to perform the service. Code 62370 should be reported when the service does require a physician's skill.

Codes 62367 - 62370 should not be reported with codes 95990 and 95991. Codes 95990 and 95991 should be reported for refilling and maintenance without reprogramming (when performed) on a reservoir or an implantable infusion pump for spinal or brain drug delivery.
 
Pain Pump Meds

I heard some doctors are having the patients bring in their own meds for refilling the pain pump because they lose money when the doctor purchases the meds. How does the patient get the meds? Can they just call directly to the drug rep or does the doctor write a prescription and they get it filled at their pharmacy?

The meds that are used are: Bupivacaine PF 10mg/ml
Fentanyl CIT PF 2000mcg/ml
Hydromorphone PF 15mg/ml
Medtronic Refill Kit

Our cost is: 312.24 plus 28.00 for the refill kit. How do we get reimbursed what it costs us? Thanks for your help.

Caroline
 
http://www.cms.gov/Medicare/Quality...Statute_Regulations_Program_Instructions.html

Above is the link to access the 2013 final rule which you can then search "intrathecal pump" and review the stance they have on potentially the patient having the pharmacy bill the insurance.



• Drugs specified by the statute. These include a variety of drugs, such as oral immunosuppressives and certain vaccines. Depending on the circumstances, drugs used to refill an implanted intrathecal pump can be paid under either the ‘‘incident to'' or the DME benefit category or Medicare Part D. The CMS Benefit Policy Manual (100–02 Chapter 15 Section 50.3) states that drugs paid under the ‘‘incident to'' provision are of a form that is not usually self-administered; are furnished by a physician; and are administered by the physician, or by auxiliary personnel employed by the physician and under the physician's personal supervision. Section 60.1 A requires that ‘‘to be covered, supplies, including drugs and biologicals, must represent an expense to the physician or legal entity billing.'' In what we believe is a typical situation, when physicians' services are used to refill an intrathecal pump, the ‘‘incident to'' requirements can be met because, consistent with our guidance and longstanding policy, the physician or other professional employed by his or her office performs a procedure to inject the drug into the implanted pump's reservoir (that is, the drug is not self- administered), and the drug represents a cost to the physician because he or she has purchased it. Conversely, we believe that in the typical situation, payment to a pharmacy or other nonphysician supplier under the DME benefit for a drug dispensed for use in the physician's office is both inappropriate and inconsistent with existing guidance.
 
I have several pain management groups...
The drug code you would bill to Medicare for Morphine, Hydromorphone, Bupivicaine, Clonidine is J7799 KD. you bill only one unit of J code even if there are multiple drugs on invoice, enter the drug(s) information in block 19 of HCFA, and make sure the appropriate NDC number(s) is on the claim. As for billing amount, you take the invoice times 1.5 and then add $60.00.
 
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