Wiki Pain Pump Replacement???

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lcole7465

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My doctor did an intrathecal pump replacement and re-position with intra-operative programming of the pump.

I infiltrated the area of the abdomen with 10mL of local anesthetic, bupivicaine 0.5%, then we used an 11 blade and made a transverse incision over the old incision and then I used a sharp and blunt dissection. I was able to expose the pump, then I aspirated from the catheter access port to the pump and that produced free flow of clear CSF. Then I made a sharp and blunt dissection to re-position the pump more anterior so it does not rub over the left ASIS which is one of the patient's main complaints. Then I connected the catheter to the new pump. I secured the pump to the abdominal fascia using 2-1 Tycron, 3 stitches were taken into the abdominal fascia. Then I irrigated all the incisions. I closed the subcutaneous tissue with 2-0 Vicryl followed by 3-0 Vicryl followed by 3-0 Novafil.

He wants to code 62360, but I'm going more towards 62362 with the re-position being inclusive as he didn't make a different incision to re-position the pump, just deeper in the same pocket. Am I correct in this rational???

Thank you
 
Below is provided by Medtronics guide for reimbursement and coding for targeted drug delivery

"Revision of Pump----- 64999 Unlisted procedures, nervous system"

"12. Pump revision includes procedures such as reshaping the pocket, relocating the pocket, or opening the pocket to correct a flipped pump or reconnect the catheter, all while
re-inserting the existing pump without replacing it with a new pump. There is no CPT code specifically defined for pump revision so an unlisted code is used. For Medicare,
the unlisted code is contractor-priced. Contractors establish the RVUs and the payment amount, usually on an individual basis after review of the procedure report."

http://www.medtronic.com/content/da...-drug-delivery-commonly-billed-codes-2018.pdf
__________________________________________

Need to indicate to the physician CPT 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir describes implanting or replacing the device. If the this a programmable pump and there was a replacement that took place of the pump reservoir/battery than CPT 62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming, would support a replaced device for a programmable pump.

But if this just is a revision of an existing pump, although 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, includes providing a revision to the catheter, there is currently no CPT for revision of an existing implanted intrathecal pump and as seen above from Medtronics that revision is unlisted.
 
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