# 5-FU and Portable Pump Billing



## plugger10 (Mar 17, 2014)

When you administaer 5-FU in the office via IVP along with other infused Chemo Drugs and then before the pt leaves you hook them up to a portable pump that infuses 5-FU over 46 hours, how do you bill the admin for the push and the pump?


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## dtricia (Mar 17, 2014)

*5fu*

The push is billed 96411. The 5fu that goes home in the pump is hooked up and billed with 96416. Put a modifier 59 on your 96413. If the patient comes back for a refill of the 5FU , then you would use 96521. 
If this patient is Medicare you are going to bill the drug to DMERC and the place of service will be HOME.
Tricia D.


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## crhunt78 (May 21, 2014)

dtricia said:


> The push is billed 96411. The 5fu that goes home in the pump is hooked up and billed with 96416. Put a modifier 59 on your 96413. If the patient comes back for a refill of the 5FU , then you would use 96521.
> If this patient is Medicare you are going to bill the drug to DMERC and the place of service will be HOME.
> Tricia D.


Do you know what you would code if the drug being infused in the pump is a therapeutic drug like Mesna?


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## OCD_coder (Jun 11, 2014)

HILLIC,

Mesna is a chemo drug J9209 and the 96416 would be the appropriate code if a pump was used and more than 8 hours of delivery of the drug were documented.

To the originating question, either a 96409 or 96411 would be appropriate for the push of 5FU.  The push is given as the patient must obtain a certain level of chemo in the system in order to protect the kidney's from damage.  A pump cannot begin without the push being performed first.  The push is administered through a different port/opening/tubing into the patient and a modifier 59 is not necessary.  If an infusion of another chemotherapy drug is given typically oxaliplatin 96413 would be the initial and the 96411 is coded secondarily.  

http://www.healthleadersmedia.com/c...questions-about-injections-and-infusions.html

I respectfully disagree with dtricia to the posted information as I have been billing/coding oncology for almost 8 years.  Modifier 59 on the 96413 is incorrect as there is no bundling affected and billing the drugs to the DMERC would be incorrect also, all the charges from an oncology clinic are billing to Medicare Part B and you would bill to the clinic POS 11 as that is where the pump is filled and require a level of supervision by the provider.


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## dtricia (Jun 12, 2014)

*Pumps as Durable Medical Equipment*

I bill the drugs as a supply to the DME pumps. The pumps are covered under DME benefit.
I get a Cerificate of Medical Necessity prior to starting home pump billing for these patients.
External infusion pumps are covered under the DME benefit category.
dtricia


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## alannae (Jun 12, 2014)

I agree with True Blue.

dtricia, what kind of provider do you bill for?


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## OCD_coder (Jun 12, 2014)

Chemo drugs are not given in a home infusion pump (99601 - 99602 = POS 12) and have to be supervised by an oncologist due to the drug toxicity by the administering nurse and the patient.  So I can only question what drug you are administering as via the home.

Yes, the patient takes the pump home once the oncologist/clinic loads the chemo drug cartridge into the pump 96416/Chemo drug infusion lasting longer than 8 hours.  I am very curious to understand what drugs you are actually billing for and more specific details to what services are performed by your provider.

*Addendum:*
I have been looking into the DMERC question all morning and found this source of information.  There is no indication that infusion drugs (especially chemotherapy) are to be billed to the DMERC, this is a facility billing issue and does not apply to all infusion centers as some are free-standing clinics.  But our facility infusion center bills all our drugs to the FI.  We do not dispense oral anti-cancer drugs and most do not, that is not to say that someone doesn't.

I am really very curious to learn something new, so all comments are welcome.

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM4301.pdf


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## dtricia (Jun 13, 2014)

*Dme*

https://www.noridianmedicare.com/dme/coverage/docs/lcds/current/external_infusion_pumps.htm

https://www.noridianmedicare.com/dm...ion_pumps_coverage_and_billing_reminders.html


This is from our local carrier Noridian.
This was for a free standing Clinic


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## OCD_coder (Jun 13, 2014)

I have several oncology clinics I am involved with that fall under Noridian.  
The information you provided only applies if the clinic owns and chooses to bill for the DME side of infusion pumps and meets the criteria on the DME drug LCD.   Our clinics have chosen not to bill DMERC for the pumps per the decision of our board (not my decision).  

So I cannot concur with your information as applicable to the question posted for this string, it only applies to DMERC billing.  DMERC does not pay for administration codes e.g. 96416, 99601, 99602 for pump infusions.  Most infusion clinics bill the drugs to their Fiscal Intermediary, MCR Part B.


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## acw (Jul 10, 2014)

I agree with OCD Coder.  I do the same billing, and do not use a -59 on the pump refill nor do I bill DMERC.  It all goes to Medicare on a 1500, and have no denials from NGS Medicare or any of the other commercial payers.
Annette


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## vpcats (Jul 17, 2014)

Good morning.

I am fairly new to oncology coding and have a situation that is driving me nuts.  

Patient has a 14 hr ambulatory pump of Desferal (deferoxamine) filled every day.  She comes, she goes.  

What code would you use for this?  I saw something in Revenue Cycle Pro about a C code but unsure if this is what I should use.   I do facility, outpatient coding.

Thanks for your help.  Patient's charges are piling up looking for answers.


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## SJCCPC (Apr 27, 2016)

*Billing DMERC and Medicare?*



OCD_coder said:


> Chemo drugs are not given in a home infusion pump (99601 - 99602 = POS 12) and have to be supervised by an oncologist due to the drug toxicity by the administering nurse and the patient.  So I can only question what drug you are administering as via the home.
> 
> Yes, the patient takes the pump home once the oncologist/clinic loads the chemo drug cartridge into the pump 96416/Chemo drug infusion lasting longer than 8 hours.  I am very curious to understand what drugs you are actually billing for and more specific details to what services are performed by your provider.
> 
> ...




Hi OCD Coder,

 We have been billing the E0781 (Pump) and (A4222)  to DMERC for years. We own the supplies for the locations we bill DMERC. Medicare is billed the clinical portion, OV's and other drugs to Medicare. The pump admin code 96416 is also billed on the clinical claim to Medicare.

Is this allowed? I received the article from MLN yesterday and I questioning if I am billing correctly. Am I allowed to bill both DMERC and Medicare? I saw an article that read we cannot bill both supplies and the administration codes

Some of the common drugs given via pump is Yondelis, which we bill to Medicare (Unlisted code). DMERC is billed for Mesna, Ifex, and 5FU. 

Any insight or advice would be much appreciated. 

Thank you!


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