General Surgery Coding Alert

Question: What is the appropriate code to report hyperalimentation or TPN? The only code I can find is 99562, but it's for "in the home" and I need a code for the critical care setting.

General Surgery Discussion Group Participant

Answer: Although you may report placement of a catheter for use during total parenteral nutrition, or TPN, (e.g., 36489, Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2), CPT does not contain a specific code to report ongoing management of TPN patients, including coordination with a dietitian. You may receive reimbursement for these services, however, by reporting an appropriate E/M procedure code.

For example, if the surgeon is managing the patient's nutritional status at home through calls from a home health nurse, skilled nursing facility, etc., he or she can report care plan oversight services (99374-99380). You may also report such ongoing management with the subsequent hospital care codes (99231-99233), as part of critical care services (99291-99292) or with other applicable face-to-face codes, as appropriate. Examples of common diagnoses to accompany the claim include 263.1 (Malnutrition of mild degree) and 783.6 (Polyphagia).

You note correctly that 99562 (Home infusion of total parenteral nutrition, per diem) is inappropriate for inpatient use. This code was added to CPT in 2002 to describe in-home management, per day, for TPN patients. But may payers will not reimburse separately for this service, instead bundling it to any E/M services provided.