Wiki Pump Infusions

[salinafoster]

Palmetto Medicare has just recently started denying our pump infusions for pain
the procedure codes are
62369
0475-kd
we do not use compound drugs and i bill it with the following message on line 19 of the hcfa "drugs administered thru an implanted pump".
Before July 2012 we were always paid for these procedures but now they are being denied and when i contacted Medicare they state you cannot bill these two codes together that we are to bill for the baclofen with J3490 i explained to them that we are not billing compound drugs. I was wondering if anyone is having this same problem and if you are what has been you solutions , i need help!!!!!!!!!

 

[Walker22]

I bill to Cahaba, not Palmetto, but even when the only drug is Baclofen we still use the J3490 code. It may not be compounded with other drugs, but the mixture usually contains saline. This means that it is not straight 100% Baclofen, which is what J0475 would imply. For pump refills we ALWAYS bill J3490-KD and copy the invoice information to the payer.

 

[salinafoster]

pump infusion

walker'
the baclofen does not contain saline solution it is 120-ml of lioresal intrathecal (baclofen injection) so i cannot bill the j3490

 

[Walker22]

Even though it does not contain saline, I would use the J3490-KD code. Medicare wants their pump refills to be billed with this code regardless of ingredient. This has been my experience anyway. Every rule has an exception, so I could be wrong. I've given you all the info I have. Maybe someone else can shed light on this? Good luck!