Wiki 96523 Port Flush

[Noellecherie]

This question has been brought up to me

"Saline flushes for PICC and Ports, is there a cap on how many you can charge for? Ex. PICC's actually have NS 20ml flushes for each lumen and there are two lumens. Nursing is only charting on 1 lumen. Can we get more reimbursement for all 4, or no?"

My answer was that we can only charge cpt 96523 once. Is this correct? I cannot find any official guidelines on this.

 

[thomas7331]

CMS has established an MUE edit of one per day for this code, but it is designated as based on clinical data, which means that multiple units will deny, but can be overturned on appeal if the documentation supports that multiple irrigations were performed. I imagine that in the situation you describe it would not be allowed because even if there are multiple lumens, this is a single device and a single encounter and the code description is for irrigation of a device, and should not be billed per flush. I'm guessing that supporting multiple units of this would require documentation that the second irrigation was repeated on the same day due to unforeseen circumstances.

 

[Noellecherie]

Thanks I appreciate your help. Do you know where I would be able to find this on CMS website? I just need something official to present.

Thanks Again

N