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Old 05-17-2010, 06:35 AM
mrolf mrolf is offline
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Default billing for a port flush

How would you bill for a port flush that the nurse performs. We have been billinga 99211 only. Shouldn't we be billing 96523? I don't think we can bill 99211 and 96523. Any thoughts on this? Please advise. Thanks
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Old 05-17-2010, 07:50 AM
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mitchellde mitchellde is offline
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If a code exists for the service the nurse person renders as ordered by the physician then you use that code and not the 99211 and never the 2 together.
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Old 05-17-2010, 11:36 AM
lnagai lnagai is offline
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Default billing for a port flush

We only bill w/ 96253.

Question: How do you bill for flushing of a port when this is the only service during the patient encounter?

Answer: Previously, per an article from the April/May 1997 Medicare Bulletin, we advised providers to bill for a port flush using CPT code 99211. Effective 2006, CPT code 96523 should be used instead of billing 99211. You would not bill CPT code 96523 if there is a visit or other injection or infusion provided on the same day: the port flush would be considered component to these other services. Also, do not bill CPT code 90775 (Therapeutic, prophylactic or diagnostic injection; each additional sequential intravenous push of a new substance/drug) for heparin used as a flush at the end of infusion therapy. (Note effective 010109, 90775 is replaced by CPT code 96375 which would still not be used for the flush at the conclusion of an infusion as it is considered component to the infusion administration and not separately billable). See CMS Manual 100-4, the Medicare Claims Processing Manual, Chapter 12, Section 30.5, subsection E via the following link for this advice: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Last edited by lnagai; 05-17-2010 at 11:40 AM. Reason: needed to add additional information
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Old 05-17-2010, 11:41 AM
lnagai lnagai is offline
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Default billing for port flush

Question: How do you bill for flushing of a port when this is the only service during the patient encounter?

Answer: Previously, per an article from the April/May 1997 Medicare Bulletin, we advised providers to bill for a port flush using CPT code 99211. Effective 2006, CPT code 96523 should be used instead of billing 99211. You would not bill CPT code 96523 if there is a visit or other injection or infusion provided on the same day: the port flush would be considered component to these other services. Also, do not bill CPT code 90775 (Therapeutic, prophylactic or diagnostic injection; each additional sequential intravenous push of a new substance/drug) for heparin used as a flush at the end of infusion therapy. (Note effective 010109, 90775 is replaced by CPT code 96375 which would still not be used for the flush at the conclusion of an infusion as it is considered component to the infusion administration and not separately billable). See CMS Manual 100-4, the Medicare Claims Processing Manual, Chapter 12, Section 30.5, subsection E via the following link for this advice: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
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Old 05-18-2010, 06:03 AM
mrolf mrolf is offline
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Thanks, Inagai.

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Old 05-18-2010, 07:19 AM
ealawson ealawson is offline
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I'm not sure if this is the same thing you are looking at but we bill a 99211 w/mod 25 and 36593 w/mod 59 for declotting access device for infusions.
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