How To Use CPT Code 95990

CPT 95990 describes the refilling and maintenance of an implantable pump or reservoir for drug delivery to the spinal or brain regions. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95990?

CPT 95990 can be used to describe the refilling and maintenance services provided for an implantable pump or reservoir that delivers drugs directly to the spinal or brain regions. This code is used when a clinical staff member performs the necessary procedures to ensure the proper functioning of the pump or reservoir, including electronic analysis if required.

2. Official Description

The official description of CPT code 95990 is: ‘Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed.’

3. Procedure

1. A clinical staff member identifies the center of the implanted pump or reservoir and prepares the prescribed drug for administration.
2. Using a sterile technique, she cleanses the area and attaches a Huber needle to tubing.
3. The clinical staff member punctures the skin and enters the center of the pump or reservoir using the Huber needle.
4. She withdraws any fluid present in the pump or reservoir using an empty needle.
5. The clinical staff member replaces the empty needle with the needle containing the drug and slowly injects the new drug, taking care not to overfill the pump or reservoir.
6. After administering the drug, she withdraws the tubing and needle.
7. If necessary, she may also perform electronic pump analysis during the same session to check reservoir status, alarm status, and drug prescription status.

4. Qualifying circumstances

CPT 95990 is used for patients who have an implantable pump or reservoir for drug delivery to the spinal or brain regions. The refilling and maintenance services are performed by a clinical staff member, and the procedure includes electronic analysis if required.

5. When to use CPT code 95990

CPT code 95990 should be used when a clinical staff member performs the refilling and maintenance procedures for an implantable pump or reservoir for drug delivery to the spinal or brain regions. This code includes electronic analysis if performed during the same session.

6. Documentation requirements

To support a claim for CPT 95990, the clinical staff member must document the following information:

• Identification of the center of the implanted pump or reservoir
• Cleansing of the area and use of a sterile technique
• Start and end time of the procedure
• Details of the drug administered and any fluid withdrawn
• Any electronic pump analysis performed, including reservoir status, alarm status, and drug prescription status
• Signature of the clinical staff member performing the service

7. Billing guidelines

When billing for CPT 95990, ensure that the service is performed by a clinical staff member and includes the refilling and maintenance of an implantable pump or reservoir for drug delivery to the spinal or brain regions. If electronic analysis is performed during the same session, it should be included in the billing. Take note of any specific guidelines or modifiers required by the payer.

8. Historical information

CPT 95990 has undergone several changes since its addition to the Current Procedural Terminology system. It was first added on January 1, 2003, and has since undergone code changes on January 1, 2004, January 1, 2010, and January 1, 2012. These changes have refined the description and scope of the code.

9. Examples

1. A clinical staff member refills an implantable pump with pain medication for a patient with chronic back pain.
2. A clinical staff member performs maintenance on an implantable pump delivering antibiotics to a patient with a spinal infection.
3. A clinical staff member refills a reservoir delivering chemotherapy drugs to a patient with brain cancer.
4. A clinical staff member performs electronic analysis on an implantable pump delivering medication to a patient with Parkinson’s disease.
5. A clinical staff member refills an implantable pump with medication to manage spasticity in a patient with multiple sclerosis.
6. A clinical staff member performs maintenance on an implantable pump delivering medication to control seizures in a patient with epilepsy.
7. A clinical staff member refills a reservoir delivering pain medication to a patient with cancer-related pain.
8. A clinical staff member performs electronic analysis on an implantable pump delivering medication to manage muscle spasms in a patient with spinal cord injury.
9. A clinical staff member refills an implantable pump with medication to treat a patient with intracranial hypertension.
10. A clinical staff member performs maintenance on an implantable pump delivering medication to manage symptoms of a patient with amyotrophic lateral sclerosis.