Wiki Infusion Billing

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rcmspt

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We are revamping a client's infusion billing and question previously setup coding.

i.e.
Patient was seen on 9.13.2016 and the following was coded

96365 x 1
96366 x 1 (for additional hour)
J3370 x 4 units
36592 x 1 unit
98960 x 1
99211 x 1

We did not get paid on the 96366; which is not understandable since it's an additional not an initial
we did not get paid on the 36592; which understandably is bundled, but is there a way around this and could this be the reason that the 96366 didn't get paid or should we have a modifier, however, it has been paid on other patients w/o the 36592.

OV / EM codes; can we add 25 or 59 to get that paid or regardless it will stay unpayable

98960 ~ what about this code

Any help would be appreciated.
 
I sense several issues with this
First the CPT book states that 36592 cannot be used in conjunction with any other services other than Lab.
You cannot bill a 99211 in addition to infusion services.
The J3370 is an injection code not an infusion which would explain why they are not paying for the second hour. Was this provided IVpush, or was it added to the primary bottle. You need to add the code for the primary solution. or was this 4 separate IV push occurances.
what was the education and training for? what dx codes did you supply which each of these.
for the 98960 you must have documentation of training and education for the patient to self manage an issue and be able to provide documentation that the nurse was properly trained to provide this training.
 
Thanks.

Here are my responses/questions; thank you for your help.. :)


First the CPT book states that 36592 cannot be used in conjunction with any other services other than Lab.
** since we aren't a lab we cannot bill for this? They send the specimen to the lab(s); so should there be another code?

You cannot bill a 99211 in addition to infusion services.
** We understand that; was hoping there might be another option or modifier if applicable

The J3370 is an injection code not an infusion which would explain why they are not paying for the second hour. Was this provided IVpush, or was it added to the primary bottle. You need to add the code for the primary solution. or was this 4 separate IV push occurances.
*** This was/is the drug placed into the solution for the infusion gravity bag

what was the education and training for? what dx codes did you supply which each of these.
for the 98960 you must have documentation of training and education for the patient to self manage an issue and be able to provide documentation that the nurse was properly trained to provide this training.

*** Dx Code is L03.116 / 98960 was/is use for the nurse to review and educate the patient on the process typically only billed at initial start of care.
we do document this in the EHR, however, getting it paid is another thing. :)
 
So is the J code for the primary solution included?
No there is no modifier you can add to the 99211, it should not be billed.
I do not think the 98960 will be reimbursed on the same day as the infusion, I have been paid when it is the only service provided.
The 36592 cannot be billed with any other service, like the infusion, it would be billed either stand alone if you are sending the labs out or with the lab codes if you do them inhouse.
 
Thanks ... :)

So is the J code for the primary solution included?
** This is the only drug infused..
No there is no modifier you can add to the 99211, it should not be billed.
**Darn.. :)
I do not think the 98960 will be reimbursed on the same day as the infusion, I have been paid when it is the only service provided.
*** So should we just not include it (or w/ initial Office Visit)

The 36592 cannot be billed with any other service, like the infusion, it would be billed either stand alone if you are sending the labs out or with the lab codes if you do them inhouse.
*** You mean stand alone that I create a second claim for same date w/ just that code?? do I add a 25 modifier??

Additional question

1. Can you do multiple date(s) of service on 1 claim for same services rendered
 
You cannot create a second claim for the same day, the 36592 cannot be billed on the same date of service as the infusion. stand alone means that is the only service provided on that date of service.

The vancomycin is the only drug infused but there is a primary solution like D5W that it is added to. You must bill for that as well.

the service to educate the patient at the same time as the provider encounter would be included in the provider encounter. The 98960 will bundle into that as well. To provide the patient with information regarding the infusion and the care of the affected area is really part of the infusion service and is not separately billable. How much time is being spent to this? what exactly is the nurse training the patient to perform?

As far as multiple dates on the same claim, I have found this to be more payer specific. in theory yes you can do this.
 
Thanks

Thank you for your help.....

we have another issue that we can't seem to get a good response... It's w/ BCBS... the codes billed were S9501 / J3370; the S9501 wsn't paid stating it was a global code.
the 1st initial visit of this treatment was billed the same w/ 96521; succeeding were not. Is this why? Should 96521 be billed daily w/ these codes?
Also; the biller that did this prior states w/ BCBS we are supposed to bill w/ POS 12 which is home; even though BCBS states that there is not restriction on the S950x code to have to be w/ POS 12.

Thank you for your help.....
 
OTE=rcmspt;409754]Thank you for your help.....

we have another issue that we can't seem to get a good response... It's w/ BCBS... the codes billed were S9501 / J3370; the S9501 wsn't paid stating it was a global code.
the 1st initial visit of this treatment was billed the same w/ 96521; succeeding were not. Is this why? Should 96521 be billed daily w/ these codes?
Also; the biller that did this prior states w/ BCBS we are supposed to bill w/ POS 12 which is home; even though BCBS states that there is not restriction on the S950x code to have to be w/ POS 12.

Thank you for your help.....[/QUOTE]

Hi, Infectious Disease practice in GA with our own office infusion suite. Is this for a patient sent home with gravity balls for home infusion? If so, then your biller is correct that the services should be billed with POS -12 because that is were the services are being performed. S9502 - Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem. 96521 can only be billed if the nurse actually saw the patient that day. Hope this helps.
 
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