Wiki Billing for ketamine for pain management

[NWilliams0408]

I have a Dr. (she is a Pediatric Anesthesiologist) in the pain clinic that is wanting to bill for a ketamine infusion for pain management on the professional side instead of the nurse billing it on the hospital side. Do you know requirements necessary for a provider to bill professionally instead of this being billed by nursing on the facility side or is that even allowed in the hospital outpatient setting?

 

[thomas7331]

A provider can bill for drugs and infusions done in their own office, as an 'incident to' service, but not in a facility. When an infusion is done in a hospital, the drugs, supplies, equipment and staffing resources are all the facility's responsibility and there is no professional component of an infusion for a physician to bill. If the patient requires evaluation or other treatment by the physician during the course of an infusion (e.g. an IV cannulation that requires the physician's skill), then the physician can bill the appropriate E/M service or other CPT code for that work, but not for the infusion itself.

 

[NWilliams0408]

A provider can bill for drugs and infusions done in their own office, as an 'incident to' service, but not in a facility. When an infusion is done in a hospital, the drugs, supplies, equipment and staffing resources are all the facility's responsibility and there is no professional component of an infusion for a physician to bill. If the patient requires evaluation or other treatment by the physician during the course of an infusion (e.g. an IV cannulation that requires the physician's skill), then the physician can bill the appropriate E/M service or other CPT code for that work, but not for the infusion itself.

Thank you!