Outpatient Facility Coding Alert

Question: How do we report S-codes for nurse visits with medicines coupled with pump rental for a patient who is receiving infusion services at home? The patient has been ordered to receive Vancomycin 1 gm BID, Cipro 40mg BID, Nexium 40mg OPD, Clexane 40mg OPD with 24-hour hydration. The order also specifically mentioned nurse visits and pump rental.

Ohio Subscriber

Answer: The S-codes in HCPCS are temporary national codes established by private payers.  The codes represent drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. These codes are also used by the Medicaid program, but they are not payable by Medicare.

The following S-codes apply to the situation you describe:

• S9501 (Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment [drugs and nursing visits coded separately], per diem) for each day (24-hour period) of the service
• S9373 (Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment [drugs and nursing visits coded separately], per diem [do not use with hydration therapy codes S9374-S9377 using daily volume scales]) for each day of service.

Remember: Check payer guidance when reporting S-codes.

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