Reader Questions: OPAT

Question: We provide outpatient parenteral antimicrobial therapy (OPAT) as a part of the office practice in which we most often see the patient weekly for physician visit, PICC care, lab draws and delivery of meds/supplies. We have had some problems with reimbursement for the per diem rate and would like to know is there a particular code for per diem nursing and supplies. Also, for OPAT patients taking medications home for self-administration, do you show place of service as home or office?

Ohio Subscriber

Answer: Based on the information submitted you should report an evaluation and management (E/M) code (99211-99215), the blood draw (36415/G0001) and the HCPCS code for the medications and/or other supplies. The PICC care (e.g., irrigation) is included in other services such as an office visit, and is not reported separately.

The correct place of service for reporting medications and/or supplies sent home with the patient is the patients home (12). Self-administered drugs, however, are not a benefit of Medicare. Payment is the patients responsibility. Additionally, when dispensing supplies to a Medicare patient for home use, the claim for payment is submitted to DMERC for processing.

Source for Reader Question: Sandy Page, CPC,
CCS-P, co-owner of Medical Practice Support Services Inc., a multispecialty consultation business in Denver that provides coding, reimbursement and compliance support to physician practices nationwide.


- Published on 2000-07-01