Wiki Infusion Pump Billing

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kendalllc

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Hi-

I was wondering if anyone can give me appropriate guidelines on whether or not it is appropriate to bill for chemotherapy infusion pump removal? I typically bill 96416 when the pump is placed, and 96521 if the patient has to come back in for a medication refill. The previous biller was using 96523 for pump removal. However, I do not think that this is correct. Any information would be greatly appreciated!
 
Infusion Pump billing

I too am having the same issue at my facility.

CPT chemotherapy guidelines state that "flush at conclusion of infusion" is included in the chemo admin charge. Is the date they come back to be flushed considered the conclusion?

Even though the billing is on a different day, I believe payers might come back and claim it is not separately billable citing the CPT chemotherapy guidelines.

I can't find a clear answer but we are still researching. Will update if and when I get a clear answer.

:confused:
 
When we went looking for clarification on this issue, we were told different things by different payers. We were told to bill either the 99211 (if the documentation supports) or the 96523 (payer dependent).

It's one of those 'real-world' things where the CPT guidelines don't necessarily line-up with what the payers want you to do. I would start by checking with your medicare contractor.
 
The correct way to bill for a pump d/c is 99211 - there is no CPT code for the pump d/c so you bill 99211 with V58.81 as the diagnosis code. V58.82 might be an appropriate dx code as well.
 
Infusion Pump billing

Hello,

I would recommend checking with your local MAC to see what they require you to charge for the pump disconnect. Some require 96523 (port flush) while others want 99211 (low level evaluation and management service).

Something to keep in mind... 96523 can not be billed with any other service on the same day other than lab services.

Hope this helps.
 
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