Boost Reimbursement for Infusion-Pump Use

Infectious disease (ID) physicians are making greater use of infusion pumps in antibiotic therapy. But ID practices that have been billing for both medication administration and the use of infusion pumps may experience difficulty getting reimbursed for the latterand with good reason. They are wrong to bill and expect reimbursement for both.

The use of external or internal infusion pumps in the office is not a billable item, says Dianna Hofbeck, RN, CCM, president of North Shore Medical Inc., a specialty medical billing service in Abescon, N.J. The proper way to bill for the use of an infusion pump during in-office drug therapy is to use infusion codes 96410-96423 (drug administration, infusion technique), she says. If the ID physician sends the patient home with a pump, however, he or she cannot use 96410-96423 because there was no office administration of drugs. Instead, Medicare considers the drug to be self-administered, and the provider is entitled to bill only for the cost of the dose.

Billing Opportunities

Commonly, when dealing with a patient who needs infusion therapy, the ID physician will fill the pump, teach the patient how to use it properly and then send the patient home to self-administer the first dose of drug therapy. The physician also provides refills for subsequent doses and instructs the patient to discontinue use when the therapy is completed. Although the physician cannot bill the infusion codes (96410-96423) when following this procedure, several billing opportunities do remain.

First, Hofbeck says, the drug administration codes can be billed. Filling and refilling the pump should be coded separately, using code 96414 (infusion technique, initiation of prolonged infusion [more than eight hours], requiring the use of a portable or implantable pump), 96520 (refilling and maintenance of portable pump) or 96530 (refilling and maintenance of implantable pump or reservoir).

You also may bill for the evaluation and management (E/M) service associated with instructing the patient on how to use the infusion pump. To bill for this, however, the requirements of an E/M visit must be met.

If a physician is not present during the visit, you must use code 99211 (established patient, office or other outpatient visit), the lowest level E/M visit for an established patient, says Hofbeck, as only 99211 does not require a physicians presence. Before correctly billing for a higher-level E/M service (99212-99215), a physician must complete and document the three components of an E/M service: history, examination and medical decision-making.

A third billing opportunity arises from the rental of the infusion pump. Some practices may be using E codes incorrectly to bill for pump rental. They also may make the error of billing the E codes to their Medicare carrier. Instead, they should bill these codes to their durable medical [...]

- Published on 2000-08-01