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The CPT® Code 96522 refers to the procedure of refilling and maintaining an implantable pump or reservoir used for drug delivery in a systemic manner, such as through intravenous or intra-arterial routes. This procedure is essential for patients requiring prolonged infusion of various therapeutic agents, including chemotherapy drugs, monoclonal antibodies, biologic response modifiers, and other antineoplastic substances. Prolonged infusion is specifically defined as the administration of these drugs over a duration exceeding eight hours, which necessitates the use of specialized devices like implantable pumps. These pumps are designed to hold a specific volume of the prescribed medication, which is then programmed to be delivered continuously at a predetermined rate over an extended period. During the procedure, healthcare professionals ensure that the pump is functioning correctly and that the medication is being delivered as intended, thereby optimizing treatment efficacy and patient safety. It is important to note that for external portable pumps, a different code, 96521, is utilized, while 96522 is specifically designated for implantable pumps or reservoirs.
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The procedure associated with CPT® Code 96522 is indicated for patients who require the continuous delivery of medications through an implantable pump or reservoir. The following conditions or situations may warrant this procedure:
The procedure for refilling and maintaining an implantable pump or reservoir involves several critical steps to ensure proper function and medication delivery. Each step is essential for the successful administration of the prescribed treatment.
After the procedure, patients are typically monitored for any immediate adverse reactions or complications related to the refill. It is essential to observe the site of the pump for signs of infection, such as redness, swelling, or discharge. Patients are advised to follow specific post-procedure care instructions, which may include keeping the area clean and dry, avoiding strenuous activities, and adhering to any prescribed medication regimens. Follow-up appointments are crucial for assessing the pump's functionality and ensuring that the medication is being delivered effectively. Regular monitoring helps to adjust dosages as needed and to address any issues that may arise during the course of treatment.
| Short Descr | REFILL/MAINT PUMP/RESVR SYST | Medium Descr | REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC | Long Descr | Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 1 | CCS Clinical Classification | 237 - Ancillary Services |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2011-01-01 | Changed | Medium description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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