Diagnosis: Low back pain.
Treatment: pain management services- implant spine infusion pump.
The insurer denied pain management services- implant spine infusion pump.
The determination is overturned.

The patient has a history of a previous intrathecal morphine pump that was implanted previously with good pain control. She has been having localized pain at the pump site, due to the pump reservoir being mobile in the pocket to the point of flipping back and forth. There are no signs of infection. The provider recommended revision of the pain pump reservoir, specifically to secure it in the pocket. The actual reservoir per se does not need to be replaced. At issue is the medical necessity of pain management services- implant spine infusion pump.

The patient has hypermobility of her pump with pain, and also carries a risk of future malfunction. The procedure is medically necessary.
The request for revision of the morphine pump reservoir is medically necessary. The pump reservoir is relatively large and can cause pain or discomfort. The pump is very mobile, to the point of flipping back and forth. This is not only a pain issue, but there is risk of malfunction of the device with this hypermobility.
There is evidence in the literature of device complications, including hypermobility of the reservoir. Noon et al cite "Intrathecal (IT) pumps are sophisticated, implantable, mechanical devices designed to safely deliver pain medications to patients with chronic pain and spasticity over long periods of time. An IT drug delivery system consists of an intrathecal catheter and a "pump"-a device containing a drug reservoir, pumping mechanism, and often a battery for driving drug delivery. Each of these components can fail and lead to serious and potentially lethal complications due to either human error and/or device failure. Device stalls, pump flips, battery failures, and catheter fractures can present as acute underdosing, resulting in medication withdrawal symptoms. Over-infusion of medication due to malfunctioning of the pump delivery system can also occur, resulting in an acute medication overdose. Both under- and over-infusion states are dangerous complications and potentially lethal. Pucks-Faes cite in a series "Pump-related problems were caused by hypermobility (1/32) and by pump site infections (3/32 in three patients". Lastly, Ahmad et al cite "Besides adverse effects, there are not many serious complications reported for intrathecal drug delivery system implantation itself. Some of the common complications are infection of the meninges, granuloma formation at the tip of the subarachnoid catheter, bleeding or hematoma at the site of the surgery, and malfunctioning of the device. Theses device malfunctions are reversible and the rest of the complications are treatable".