Wednesday, June 26, 2019
Reimbursement Coding Articles

Coding Articles


Pump Implants

CPT 2013 updated the definition of pump refill codes 62370 and 95991. Instead of requiring a physician’s skill, the descriptors for the codes state the service must require the skill of "a physician or other qualified health care professional."

You’ll find that guidance on what makes a refill skilled in the CPT Assistant for August 2012. A review of pain pump refill codes includes examples of when it would be appropriate to report these codes:

  1. Cases where access is difficult or painful for the patient because of the presence of scar tissue, myofascial pain or other disease in the port’s area.
  2.  The provider uses intravenous sedation or fluoroscopy to identify the pump and refill port.
  3. Instrumentation is needed to find and hold the pump in place.

Tip: Check state scope of practice and licensing requirements if non-physician practitioners (NPPs) will perform these services, CPT Assistant notes.

Tip: Remind physicians and qualified NPPs that their documentation should support the use of these codes. The chart should include information, such as a diagnosis code, when a patient’s condition requires the clinician’s skill. This is particularly important when the clinician performs an additional, billable service such as fluoroscopy with the procedure.

Copyright 2019 by Santa Clara County Medical Association