Wiki Billing for CIV pumps

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jbrandt

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Hi,
I'm in Ohio & our MAC carrier (CGS) recently stopped paying home health agencies for providing continuous infusion in the home setting for drugs such as 5FU. We are now setting the patient up here in our office (drug being put into the pump, patient being instructed on pump operation etc), they go home with the pump providing the continuous infusion & either a caregiver has been instructed on pump disconnection or they come back to the office for disconnection. The pump is maintained & kept by us for use by that specific patient the next chemo cycle. CGS has instructed us to use G0498 for the pump initiation (this is a carrier specific code & CGS hasn't been very forthcoming with instructions on using it). My question is for all subsequent cycles of 5FU should we bill 96521 (refilling and maintenance of a portable pump)? Or is each cycle of 5FU billed as the initiation (G0498) because the pump is disconnected between visits? Any help in clarifying this situation would be appreciated. Thanks very much!
 
jbrandt said:
Hi,
I'm in Ohio & our MAC carrier (CGS) recently stopped paying home health agencies for providing continuous infusion in the home setting for drugs such as 5FU. We are now setting the patient up here in our office (drug being put into the pump, patient being instructed on pump operation etc), they go home with the pump providing the continuous infusion & either a caregiver has been instructed on pump disconnection or they come back to the office for disconnection. The pump is maintained & kept by us for use by that specific patient the next chemo cycle. CGS has instructed us to use G0498 for the pump initiation (this is a carrier specific code & CGS hasn't been very forthcoming with instructions on using it). My question is for all subsequent cycles of 5FU should we bill 96521 (refilling and maintenance of a portable pump)? Or is each cycle of 5FU billed as the initiation (G0498) because the pump is disconnected between visits? Any help in clarifying this situation would be appreciated. Thanks very much!
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We bill G0498 on the day the pump was initiated. So for every cycle that the patient get the pump we bill G0498. 96521 we only bill if the patient came in to the office only to get the pump refilled. I hope this helps.
 
We also use the G0498 for this situation and only use the 96521 if the patient comes in has the pump refilled and is hooked back up on same day.
 
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