Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill
CPT4 code
Name of the Procedure:
Electronic Analysis and Reprogramming with Refill of Programmable Implantable Pump for Intrathecal or Epidural Drug Infusion
Summary
This procedure involves the electronic evaluation and reprogramming of an implanted pump that delivers medication directly into the spinal fluid (intrathecal) or the space outside the spinal cord (epidural). The process includes checking the status of the drug reservoir, alarms, and prescription settings, followed by refilling the pump with medication.
Purpose
The procedure addresses chronic pain or severe muscle spasticity that has not responded well to other treatments. The goal is to ensure that the pump is functioning correctly, delivering the right dosage of medication, and to refill the reservoir with the necessary drug, providing continuous symptom relief.
Indications
- Chronic pain from conditions such as cancer, failed back surgery syndrome, or complex regional pain syndrome.
- Severe spasticity due to spinal cord injuries, multiple sclerosis, or cerebral palsy.
- Patients requiring long-term, continuous drug delivery to manage symptoms.
Preparation
- Patients may be instructed to fast for a few hours before the procedure.
- Regular medications should be discussed with the healthcare provider; some medications may need adjustment.
- Pre-procedure diagnostic tests to assess overall health and baseline pump function.
Procedure Description
- The patient arrives at the healthcare facility and is prepped for the procedure.
- Local anesthetic may be applied at the pump site.
- A clinician uses a programming device to electronically analyze the pump's functioning, checking reservoir status, alarm status, and prescription settings.
- Based on the analysis, the pump’s settings may be reprogrammed to adjust medication dosages or delivery rates.
- The pump's reservoir is refilled with the appropriate medication using a sterile technique.
- The procedure is concluded with the monitoring of the patient's immediate response.
Tools/Technology Used:
- Programming device for electronic analysis and reprogramming
- Sterile needles and syringes for the refill
- Local anesthetic (if applicable)
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
Performed in an outpatient clinic, hospital, or surgical center.
Personnel
- Pain management specialist or other qualified physician
- Nurse or medical assistant
- Device technician, if needed
Risks and Complications
- Infection at the pump site
- Bleeding or bruising
- Pump malfunction or programming error
- Leakage of medication
- Adverse reaction to the medication upon refill
Benefits
- Accurate and efficient management of chronic pain or spasticity
- Reduced oral medication intake and associated side effects
- Improved quality of life and functional ability
- Immediate symptom relief post-refill
Recovery
- Patients can usually go home shortly after the procedure.
- Minimal site care, such as keeping the area clean and dry.
- Awareness of any signs of infection or complications.
- Follow-up appointment as directed by the healthcare provider.
Alternatives
- Oral or injectable pain medications
- Non-invasive pain management therapies (e.g., physical therapy or nerve blocks)
- Surgical intervention or other invasive pain relief implants
Pros of Alternatives:
- Less invasive options available
- Suitable for patients not eligible for pump implantation
Cons of Alternatives:
- May not provide as effective or consistent symptom management
- Potential for increased side effects or more frequent dosing requirements
Patient Experience
- Patients might feel minor discomfort at the pump site during programming and refill.
- Local anesthetic can minimize pain during the procedure.
- Post-procedure, some soreness or tenderness at the incision site may occur.
- Pain management and comfort measures will be provided as needed.