95991 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 p

Name of the Procedure:

Refilling and Maintenance of Implantable Pump or Reservoir for Drug Delivery (Spinal - Intrathecal, Epidural, or Brain - Intraventricular)

Summary

This procedure involves refilling and maintaining an implanted pump or reservoir that delivers medication directly to the spinal cord or brain. The process includes a thorough check of the pump's electronic functions and is performed by a qualified physician or healthcare provider.

Purpose

The procedure addresses chronic pain, spasticity, and certain neurological conditions. The goal is to ensure continuous, effective drug delivery and maintain the functionality of the implantable pump.

Indications

• Severe chronic pain unresponsive to oral medications
• Spasticity in conditions such as multiple sclerosis or cerebral palsy
• Neurological conditions requiring precise medication delivery
• Poor response to other forms of drug administration

Preparation

• Patients may need to fast for a few hours before the procedure.
• Certain medications may need to be adjusted or paused.
• Diagnostic tests, such as imaging or lab work, might be required to ensure proper placement and function of the pump.

Procedure Description

1. The patient is prepared and positioned in a sterile environment.
2. Skin over the pump area is cleaned.
3. A needle is inserted into the reservoir to withdraw any remaining medication and refill it with the new dose.
4. The pump's electronic functions are tested and calibrated.
5. Tools such as syringes and programming devices are used.
6. Local anesthesia is typically administered to numb the injection site.

Duration

The procedure usually takes about 30 minutes to an hour.

Setting

The procedure is conducted in an outpatient clinic, hospital, or surgical center.

Personnel

• Physician or qualified healthcare provider
• Nurse or medical assistant
• Sometimes an anesthesiologist, if deep sedation is necessary

Risks and Complications

• Infection at the injection site
• Bleeding or bruising
• Pump malfunction or electronic failure
• Adverse reactions to the medication

Benefits

• Effective management of chronic pain or spasticity
• Improved quality of life
• Reduced need for oral medications and their side effects
• Immediate improvement in symptoms following the procedure

Recovery

• Patients can usually go home the same day.
• Monitoring for signs of infection or adverse reactions is important.
• Follow-up appointments are typically scheduled to ensure proper pump function.

Alternatives

• Oral or transdermal medication
• External drug pumps
• Surgical interventions for pain or spasticity management
• Each alternative comes with its own set of risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

• The procedure is generally well-tolerated with minimal discomfort.
• Pain at the injection site is usually mild and temporary.
• Patients should avoid strenuous activities for a few days.
• Pain management and comfort are prioritized throughout the process.