Infusion Services

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I am hoping if anyone can help me out here. Our hospital is billing infusion services and procedure code 36593 (De-clotting by thrombolytic agent of implanted vascular access device or catheter) under revenue code 361. The payer is denying all our infusion services and paying only the surgery services as they indicate the facility rule is surgical over infusion. The issue is this minor “surgery” is only allowed at a small rate so the entire claim is paying at this low surgical rate. For example, a $79,044.74 claim only allowed $851.94 due to the 36593 billed on the claim. Our hospital is very upset because they want the infusion paid over the surgical. Please let us know how can we resolve the issue with the payer. Could you let us know if this common and if there is any way around this in the future? Should we change our billing practices, as payer indicated we must bill the surgery and the infusion services separately. This is going to continue to happen as we bill this procedure with their infusion on many members.
If anyone else has any additional questions or explanation please feel free to give your input, as I am not sure I captured what we are looking for entirely
 

cmoser3635

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Our local Novitas (Medicare) Article ID A53049, Original ICD-9 Article ID A47797, Article Title Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents states;

If performed to facilitate an infusion or injection of a non chemotherapeutic drug, biological or cancer chemotherapy agent, the following are included and are not reported separately:
• Use of local anesthesia
• IV start
• Access to indwelling IV, subcutaneous catheter or port
• Flush at conclusion of infusion
• Standard tubing, syringes and supplies
• Preparation of chemotherapy agent(s)
• Report CPT code 36593 for declotting a catheter or port.

The above section is taken out of context, I would recommend referring to your local NCD and/or LCD for your reference. If our infusion center declots a port to perform an infusion, the 36593 is not billed.

I also don't know what infusion codes you might be billing but check if 36593 edits with the other codes either with CMS NCCN or if you have any software that you can check.

I hope this is helpful
 
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