Maximize Office Infusion Pay Up By Documenting Supply Use

Optimize reimbursement for office infusion procedures by documenting carefully all supplies and coding for all aspects of the treatment, says Dianna Hofbeck, RN, CCM, president of North Shore Medical Inc. in Absecon, N.J.

Office infusionin which physicians administer intravenous therapies as an extension of their practices has become the preferred method for treating patients with a wide variety of infectious diseases, including pneumonia (486), pyogenic arthritis (711.0), cellulitis (682.9) and osteomyelitis (730.2). Originally, physicians administered these procedures on an inpatient basis; however, since there is a 60 percent chance that patients with these disease states will develop overlying infections in a hospital setting, practitioners turned to home infusion as a delivery mechanism.

The problem with home infusion is that the industry became embroiled in kickback allegations. So, not only were physicians still liable for patient injuries and illnesses sustained in the home, but they also became exposed to the penalties contained in the Stark I and II statutes, Hofbeck points out.

Now, the industry is moving full speed ahead toward administering treatment for these infectious diseases in physician offices. Many therapies are available in the infusion field, notes Ken Horwitz, manager of the Medical Treatment Center, an ambulatory infusion center in Clifton, N.J., including: chemotherapy, hydration, pain management, blood transfusions and blood product antibiotics and immunoglobulin (IVIG).

Physicians must employ registered nurses certified in IV therapy, especially PICCs (peripherally inserted central catheters). Optimally, such treatment should take place in the physicians outpatient infusion (OPI) suite, Hofbeck asserts. OPI promotes an ideal delivery mode for the patient, physician and payor. There is continuity of care, physician control and reduced costs for patients because they dont have to be admitted to the hospital, Hofbeck explains. In addition, physicians need to maintain only minimal, just-in-time inventories of solutions and antibiotics, further reducing costs, she says.

Horwitz points out, however, that OPI often means that individuals must visit their doctors office dailyand that can be burdensome for some patients. On the other hand, such visits are part of the managed-care revolution, which stresses patient responsibility and education, says Hofbeck. The dynamics of healthcare costs today are that its more efficient for patients to be treated in physicians offices than in hospitals, she explains.

Use the following codes to obtain optimal reimbursement for office infusion procedures, says Hofbeck:

First hour of infusion90780
Additional hour of infusion90781

If blood work is ordered, code those procedures as venipuncture (G0001 for Medicare and 36415 for commercial carriers), Horwitz says. And code office supplies (for commercial carriers) as 99070.

First, payers reimburse for only about 25 percent of all office supply claims in the home infusion area. Second, payers require extensive documentation of each and every supply [...]

- Published on 2000-04-01