Oncology & Hematology Coding Alert

Question: Can you tell me how to bill for the use of infusion pumps to administer chemotherapy? We are a freestanding clinic and use our own pumps. We currently use E0781 for the use of the pump and E1399 for the supplies. Some insurance companies are having problems with our codes.

Texas Subscriber

Answer: The code E1399 (durable medical equipment, miscellaneous) is incorrect if pump supply reimbursement is what you are seeking. This code is for oxygen-related equipment, not for IV supplies.

Code E0781 (ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient) is the correct HCPCS code for the portable ambulatory infusion pump and infusion supplies. A certificate of medical necessity or DMERC information form (DIF) may be required for reimbursement.

External infusion pump use is covered for chemotherapy for liver cancer, either primary hepatocellular carcinoma or unresectable colorectal cancer. In addition, the pump is reimbursable if used to administer morphine for intractable cancer pain. It may be that you need to provide more information to obtain reimbursement for this pump. (See the article Boost Reimbursement for Infusion-pump Use on page 41.)

When the patient comes into the center to have the pump initiated, you should use CPT 96414 (infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump). If the patient requires return visits to have the pump refilled, the appropriate CPT code is 96520 (refilling and maintenance of portable pump). Many centers do not own the portable pumps but use a durable medical equipment (DME) provider, and then the center performs the initiation, refilling or maintenance of the pump. This method works very well because the DMEs, who are experts in obtaining reimbursement for their products, will bill for reimbursement for the infusion-pump use.

Editors note: Margaret Hickey, MS, MSN, RN, OCN, CORLN, president of the Society of Otorhinolaryngology and Head and Neck Nurses and clinical director at the Tulane Cancer Center in New Orleans answered this question.