Gastroenterology Coding Alert

Question: Patient is seen in the office and has a heparin flush of the port - Are we allowed to bill for the J codes for the heparin? I am looking at J1642 versus J1644 - We are not billing the port flush code 96523. Is that correct?

Cincinnati Subscriber

Answer: Reporting J1644 (Injection, heparin sodium, per 1000 units) in an attempt to be reimbursed for a heparin lock flush would be incorrect. According to CCI policy manual, chapter 1, section C.1, "After vascular access is achieved, the access must be maintained by a slow infusion (e.g., saline) or injection of heparin or saline into a ‘lock.’ Since these services are necessary for maintenance of the vascular access, they are not separately reportable with the vascular access CPT^® codes or procedures requiring vascular access as a standard of medical/surgical practice."

The HCPCS code, J1642 (Injection, heparin sodium, [heparin lock flush], per 10 units), specifically refers to heparin lock flush in its definition. But again, you should not report heparin separately when used for a lock flush. In fact, J4 Part B MAC TrailBlazer announced it will no longer pay for heparin code J1642, effective July 14. According to the MAC, practices often bill heparin for flushes following infusions despite Medicare’s policy that the flush is included in the infusion and isn’t separately billable (www.trailblazerhealth.com/Tools/Notices.aspx?id=13735).