Get Appropriate Reimbursement for Port Flush
Published on Tue Aug 01, 2000
Oncology practice billing staffs often wrongly assume that the pump and venous access port are one and the same. Although both are integral parts in the infusion technique and ports must be flushed with heparin routinely to prevent clotting to guarantee proper pump function, Medicare considers them separate. Maintenance of a venous port should not be confused with the flushing of the implantable infusion pump, but there are billing options.
Some oncology practices mistakenly are using 96530 (refilling and maintenance of implantable pump or reservoir) to bill for the flushing and accessing of ports used during and after chemotherapy. According to Medicare guidelines and oncology coding experts, 96530 would lead to overpayment for a service that routinely is performed by a nurse without physician supervision.
Most of the time you cant bill for the procedure, says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a Dallas, Ga.-based coding consulting firm.
Its never an acceptable charge if it is done in conjunction with chemotherapy, says Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology, an oncology practice in Hooksett, N.H.
Medicare policy on using 96530 is clear as well. According to Medicare, the accessing and flushing of the implanted infusion pump and its attached catheter either in a large vein, the epidural or subarachnoid space is included in an appropriate evaluation and management (E/M) service code as part of managing the patient. In addition, CPT code 96530 should not be reported either for the flushing of the lumen(s) of a long-term central venous access device, such as a Hickman catheter, or an implanted venous access device port like the Port-a-Cath.
Medicare maintains that 96530 should be used only for refilling of the implantable pump or reservoir with appropriate medication. The relative value unit assigned to 96530 is too high to be associated with the low complexity of accessing and flushing ports, says Parman. In addition, Medicare guidelines state that 96530 will not be allowed on the same day as 96414 (chemotherapy administration; infusion technique, initiation of prolonged infusion [more than eight hours], requiring the use of a portable or implantable pump).
According to Towle and Parman, the inappropriateness of 96530 is black and white, but oncology practices must navigate a subtle gray area when they try to bill for port flushing with other codes. In many instances, individual Medicare carriers determine the proper code, if one is available. Oncology practices should check with their local carrier to get the proper code for port flushing and codes associated with it.
Although maintenance of a venous port should not be confused with the flushing of the implantable infusion pump, Towle says her carrier, National Heritage Insurance Co., allows practices to use [...]
