Basics of Baclofen Pump Insertion
Key Terms:
- Intrathecal Pump Insertion
- Trial Intrathecal Catheter Insertion
Indications / Associated Pathologies:
Baclofen pumps are used to treat muscle spasticity caused by conditions such as:
- Cerebral Palsy
- Multiple Sclerosis
- Spinal Cord Injury
- Stroke
- Traumatic Brain Injury
Description:
The intrathecal Baclofen pump system is designed to treat moderate to severe muscle stiffness and spasticity caused by conditions such as multiple sclerosis, cerebral palsy, stroke, and spinal cord injuries. It works by delivering Baclofen directly into the spinal canal, restoring normal nerve-muscle communication.
- Baclofen can be administered orally or via an intrathecal pump.
- The pump is a small metal disk that delivers Baclofen through a catheter inserted into the spinal canal. The drug is stored in the pump and delivered to the catheter by a small motor.
- The pump can be controlled externally using a computer, allowing adjustments to dosage, rate, and timing, or it can be set to a continuous release.
Procedure:
- The Baclofen pump, measuring 1″ x 3″, is implanted under general anesthesia. A surgical incision is made (Open approach) into the subcutaneous tissue and fascia of the abdomen or the lateral side of the trunk, near the waistline.
- A second procedure involves the insertion of a small catheter, which is introduced percutaneously into the spinal canal. The catheter is threaded upward within the canal and connected to the pump, with the other end tunneled subcutaneously to the device. The incision is then closed with sutures.
Focus Points:
- Battery Life and Replacement:
- The Baclofen pump’s battery typically lasts 5-7 years. Once the battery expires, the pump must be replaced.
- Replacement requires reporting two codes: one for the Removal and another for the Insertion of the infusion pump, using the Open approach.
- Catheter Replacement:
- The catheter does not always need to be replaced with the pump. If it is replaced, additional codes for the Removal and Insertion of the catheter are required.
Body Systems Affected:
- Subcutaneous Tissue and Fascia
- Central Nervous System and Cranial Nerves
Root Operation:
- Insertion: The act of placing a non-biological device that assists, monitors, or influences a physiological function but does not replace a body part.
Body Parts Involved:
- Subcutaneous Tissue and Fascia (Abdomen, Trunk)
- Spinal Canal
Approaches:
- Open: Used for the surgical implantation of the pump and catheter.
- Percutaneous: Used for catheter insertion into the spinal canal.
Devices Used:
- Infusion Device, Pump: The device used for the Baclofen pump.
- Infusion Device: The catheter used to deliver the drug to the spinal canal.
Coding and Compliance:
- Approach Confirmation: Verify the catheter insertion approach. Use the Open approach if the procedure is performed under direct surgical vision.
- Intrathecal Pump Refilling/Reprogramming: Refilling or reprogramming during an inpatient stay is not coded.
- End-of-Life Pump Replacement: When replacing a Baclofen pump and catheter, code both the Removal and Insertion of the infusion device (pump and catheter), following specific guidelines for end-of-life replacement.
Reimbursement Categories:
- Insertion of Infusion Pump:
- MS-DRG 515-517 (Other Musculoskeletal System and Connective Tissue Procedures)
- MS-DRG 040-041 (Peripheral and Cranial Nerve and Other Nervous System Procedures)
- Trial Insertion of Intrathecal Catheter: A non-operating room procedure with no effect on reimbursement.
This structure aims to provide clarity and facilitate understanding of Baclofen pump insertion procedures, their coding, and the associated compliance and reimbursement details.