How To Use CPT Code 96522

CPT 96522 describes the procedure of refilling and maintaining an implantable pump or reservoir for systemic drug delivery. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96522?

CPT 96522 can be used to describe the process of refilling and maintaining an implantable pump or reservoir used for systemic drug delivery. This code is used when a healthcare provider ensures that the pump or reservoir is functioning properly and refills it as needed.

2. Official Description

The official description of CPT code 96522 is: ‘Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial).’ Please note that for refilling and maintenance of an implantable infusion pump for spinal or brain drug infusion, a different code should be used (95990 – 95991).

3. Procedure

1. In this procedure, the healthcare provider checks the functioning of the implantable pump or reservoir used for systemic drug delivery.
2. The provider ensures that the medicine is being delivered as required.
3. If necessary, the provider refills the reservoir by injecting the drug through a self-septum in the pump using a special needle.

4. Qualifying circumstances

This procedure is performed when a patient has an implantable pump or reservoir for systemic drug delivery. The pump or reservoir is used to administer drugs through routes such as intravenous or intra-arterial. The healthcare provider ensures that the pump is functioning properly and refills the reservoir as needed.

5. When to use CPT code 96522

CPT code 96522 should be used when a healthcare provider refills and maintains an implantable pump or reservoir for systemic drug delivery. It is important to note that this code should not be used for refilling and maintenance of an implantable infusion pump for spinal or brain drug infusion, as a different code should be used in those cases.

6. Documentation requirements

To support a claim for CPT 96522, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for refilling and maintenance of the implantable pump or reservoir
• Date of the procedure
• Details of the refill process, including the drug used and the amount refilled
• Confirmation of the proper functioning of the pump or reservoir
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 96522, ensure that the procedure involves refilling and maintaining an implantable pump or reservoir for systemic drug delivery. It is important to use the appropriate code for refilling and maintenance of an implantable infusion pump for spinal or brain drug infusion, if applicable. Take note of any specific guidelines provided by the payer regarding the reporting of CPT code 96522.

8. Historical information

CPT 96522 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider refilling and maintaining an implantable pump for intravenous drug delivery in a patient with cancer.
2. A provider ensuring the proper functioning of an implantable reservoir for intra-arterial drug delivery in a patient with cardiovascular disease.
3. A healthcare professional refilling an implantable pump for systemic drug delivery in a patient with chronic pain.
4. A provider checking the functioning of an implantable reservoir for intravenous drug delivery in a patient with autoimmune disease.
5. A healthcare provider refilling and maintaining an implantable pump for systemic drug delivery in a patient with multiple sclerosis.
6. A provider ensuring the proper functioning of an implantable reservoir for intra-arterial drug delivery in a patient with liver disease.
7. A healthcare professional refilling an implantable pump for intravenous drug delivery in a patient with HIV/AIDS.
8. A provider checking the functioning of an implantable reservoir for systemic drug delivery in a patient with kidney disease.
9. A healthcare provider refilling and maintaining an implantable pump for intravenous drug delivery in a patient with rheumatoid arthritis.
10. A provider ensuring the proper functioning of an implantable reservoir for systemic drug delivery in a patient with neurological disorder.