Clinical Context
A 58-year-old patient with chronic, refractory cancer-related pain managed with an implanted intrathecal pump presents for scheduled pump management. The patient receives intrathecal morphine via a programmable pump that requires periodic reservoir refills, performance analysis of the pump hardware/software, and occasional reprogramming of basal infusion rates. The clinical workflow begins with nursing triage assessing pain control and neurologic status, confirmation of pump type and reservoir volume via interrogation, and verification of medication and concentration. The provider performs a sterile refill of the pump reservoir, interrogates the pump to review logs and battery status, reprograms infusion parameters as indicated, documents pump performance and medication lot numbers, and provides patient education on signs of malfunction or infection. Typical monitoring includes vitals, focused neurologic exam, and observation post-refill for adverse reactions. This service is typically delivered in an outpatient ambulatory surgery center, hospital outpatient department, or specialized pain clinic with sterile capabilities and emergency support available.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | Default/Unspecified | Data systems placeholder; rarely used on claims — not typically submitted for this service |
11 | Office or other outpatient visit | When reporting an associated outpatient visit that is distinct and separately billable
22 | Increased procedural services | When work required is substantially greater than usual (e.g., complex refill with difficult access)
52 | Reduced services | When only partial pump service is performed compared to full service
53 | Discontinued procedure | When the procedure is started but stopped for patient safety or other valid reason
59 | Distinct procedural service | When this service is separate and independent from other procedures performed the same day
62 | Two surgeons | When two surgeons from different specialties are required for the procedure
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | For emergent troubleshooting requiring re-entry related to the original pump procedure
80 | Assistant surgeon | When an assistant surgeon is required and appropriate for the procedure
99 | Multiple modifiers not otherwise specified | Rarely used; when multiple uncommon circumstances apply
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an APP serves as an assistant during the procedure
GC | Service performed in part by a resident under direction of teaching physician | For teaching settings where the attending documents appropriate teaching physician presence
QX | Service performed by a physician assistant with physician supervision | When a PA performs the service under required physician oversight
QY | Service performed by a second physician assistant — state law variations | When billing rules require this distinction
| Taxonomy Code | Specialty | Notes |
|---|
207P00000X | Physical Medicine & Rehabilitation Physician (Physiatry) | Common specialty managing intrathecal pumps for chronic pain and spasticity |
207L00000X | Pain Medicine Physician | Frequently performs pump refills, interrogation, and reprogramming
2084P0800X | Anesthesiology | Anesthesiologists with pain fellowship frequently provide intrathecal pump management
208D00000X | Neurology | Neurologists may manage pumps when treating spasticity or neurologic pain syndromes
363LP0808X | Nurse Practitioner — Pain Management | Advanced practice providers commonly perform routine refills and programming under supervision
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
G89.3 | Neoplasm-related pain (acute) | Cancer-related pain requiring intrathecal opioid delivery via pump |
G89.4 | Chronic pain syndrome | Indication for long-term pump therapy when other measures fail
G83.4 | Spasticity following cerebral infarction | Intrathecal baclofen pumps are used for severe spasticity management
M47.26 | Other spondylosis with radiculopathy, lumbar region | Severe radicular pain refractory to other treatments may be managed with intrathecal analgesia
M54.5 | Low back pain | Chronic intractable low back pain that may be treated with intrathecal therapy when conservative care fails
T85.898 | Other complications of internal prosthetic devices, implants and grafts | Used when documenting pump malfunction or complication requiring analysis/reprogramming
R52 | Pain, unspecified | Symptom code used when a more specific pain diagnosis is not available but pump therapy is used
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
62369 | Analysis of pump performance and reprogramming and refill of implanted intrathecal or epidural pump | Primary service described; includes interrogation, reprogramming, and refill |
96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance) | May be used for intramuscular or subcutaneous injections given in the same visit but not for the intrathecal refill itself
11976 | Replacement and reinsertion of implanted drug delivery device reservoir (not otherwise specified) | Performed when reservoir exchange or hardware revision is required instead of a simple refill
99499 | Unlisted evaluation and management service | Rarely used for complex or atypical care coordination or counseling not represented by standard codes
99070 | Supplies and materials (e.g., sterile fluids, syringes) used during a procedure, over and above those usually included with the service | Used to bill additional supplies associated with sterile pump refill and interrogation
95992 | Device evaluation (e.g., pacemaker, neurostimulator) in the office or outpatient setting; with reprogramming | Related conceptually for device interrogation and programming of neurostimulators; shows overlap in workflow but different device class