Wiki 96416 vs 96521

Hiawatha, IA
Best answers
I'm have a discussion with one of our clients regarding when to use 96416 vs 96521.
A patient receives a prolonged infusion (usually 48 hours). We bill a 96416. The patient returns after 48 hours, the pump is removed and the patient goes home. At this point, the rented pump is placed in storage.
The same patient returns 2 weeks later for another prolonged infusion. The same rented pump is used to deliver this infusion.
What code do you use for this second infusion?

My thought was that it is another "initiation" and should be billed as another 96416.

They have been told by the pump rental company that it should be 96521 because they are using the same pump (even though it has been disconnected).

This also leads into another question, since Medicare now using G0498 which includes the pump - would this change the answer for a Medicare patient? Can we bill this multiple times if we are using the same physical pump each time?

Thanks for your guidance.
When a patient has been given a pump that has been programmed and filled for the initiation of treatment, then returns and the pump is removed and stored bill 96416 (G0498). However, if the patient comes in for initiation of treatment then returns and the pump is removed batteries are replaced, pump is inspected and medication installed and placed back on the patient, that is a 96521. The pump is being refilled and maintained for the next portion of a long term infusion. Same for the G0498.