How To Use CPT Code 95991

CPT 95991 describes the refilling and maintenance of an implantable pump or reservoir for drug delivery to the spinal or brain region. 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 95991?

CPT 95991 can be used to describe the refilling and maintenance services provided by a physician or other qualified healthcare professional for an implantable pump or reservoir. This procedure involves delivering drugs directly to the spinal or brain region to treat conditions such as infection or pain. The healthcare professional performs maintenance to ensure the proper functioning of the pump or reservoir and may also conduct electronic analysis of the pump.

2. Official Description

The official description of CPT code 95991 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; requiring skill of a physician or other qualified health care professional.’

3. Procedure

1. The healthcare professional identifies the center of the implanted pump or reservoir.
2. She cleanses the area and maintains a sterile technique throughout the procedure.
3. The prescribed drug for administration is prepared.
4. A Huber needle is attached to tubing and used to puncture the skin and enter the center of the pump or reservoir.
5. An empty needle is inserted into the tubing to withdraw any fluid present in the pump or reservoir.
6. The empty needle is removed, and the needle with the drug to be administered is inserted.
7. The new drug is slowly injected, taking care not to overfill the pump or reservoir.
8. The tubing and needle are withdrawn.
9. Electronic analysis of the pump may be performed, checking reservoir status, alarm status, and drug prescription status.

4. Qualifying circumstances

CPT 95991 is performed by a physician or other qualified healthcare professional. It is used for the refilling and maintenance of an implantable pump or reservoir for drug delivery to the spinal or brain region. The procedure requires the skill of a healthcare professional and may include electronic analysis of the pump.

5. When to use CPT code 95991

CPT code 95991 should be used when a physician or other qualified healthcare professional performs the refilling and maintenance of an implantable pump or reservoir for drug delivery to the spinal or brain region. It is important to note that CPT code 95991 should not be reported in conjunction with codes 62367-62370, which are used for analysis and/or reprogramming of implantable infusion pumps. For refill and maintenance of implanted infusion pumps or reservoirs for systemic drug therapy, CPT code 96522 should be used.

6. Documentation requirements

To support a claim for CPT code 95991, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for refilling and maintenance of the implantable pump or reservoir
• Details of the procedure, including the date and time
• Specific drugs administered and their quantities
• Any electronic analysis performed on the pump
• Signature of the physician or qualified healthcare professional providing the service

7. Billing guidelines

When billing for CPT code 95991, ensure that the service is performed by a physician or other qualified healthcare professional. It is important to follow the specific guidelines for reporting this code and to avoid reporting it with certain other codes. For example, do not report CPT code 95991 in conjunction with codes 62367-62370. Additionally, consider using CPT code 95990 when the service is performed by a clinical staff member, such as an RN. It is crucial to review the complete billing guidelines and seek clarification if needed to ensure accurate reporting.

8. Historical information

CPT code 95991 was added to the Current Procedural Terminology system on January 1, 2004. Since its addition, there have been two code changes. The most recent change occurred on January 1, 2013, which updated the description to include the requirement of a physician’s skill for the procedure.

9. Examples

1. A physician refilling and maintaining an implantable pump for intrathecal drug delivery to manage chronic pain in a patient.
2. A qualified healthcare professional performing the maintenance and electronic analysis of an implantable pump for intraventricular drug delivery to treat an infection in a patient’s brain.
3. A physician refilling and maintaining an implantable pump for epidural drug delivery to manage postoperative pain in a patient.
4. A qualified healthcare professional performing the maintenance and electronic analysis of an implantable pump for intrathecal drug delivery to treat spasticity in a patient with multiple sclerosis.
5. A physician refilling and maintaining an implantable pump for intraventricular drug delivery to manage seizures in a patient with epilepsy.
6. A qualified healthcare professional performing the maintenance and electronic analysis of an implantable pump for epidural drug delivery to treat cancer-related pain in a patient.
7. A physician refilling and maintaining an implantable pump for intrathecal drug delivery to manage neuropathic pain in a patient.
8. A qualified healthcare professional performing the maintenance and electronic analysis of an implantable pump for intraventricular drug delivery to treat a brain tumor in a patient.
9. A physician refilling and maintaining an implantable pump for epidural drug delivery to manage chronic back pain in a patient.