Billing for Cpt 96416 with 96521 on the same day

[margie513]

I have a question, are we allowed to bill for cpt code 96521 (refilling and maintenance of portable pump) and cpt code 96416?

The reason why I ask is because our CCI edits indicates that cpt 96521 would be considered bundled to 96516, further research stated that even with a 59 modifier attached to cpt code 96521 that it would be denied.

Anthem reimbursed us for it while Medicare is denying the services even with the 59 modifier. I've checked to view an updated LCD and was unable to find one.

Is someone having the same issue? please advise and/or help please.

Thank you much
Margie

[SThebarge]

You can't bill a 96416 and a 96521 in the same session. A 96416 should be billed when a patient comes in and has a pump initiated for let's say 7 days with 5FU; then the patient comes back into the office after the 7 days and gets the pump refilled with more 5FU then you would bill a 96521. The pump was never disconnected between the two visits therefore you cannot bill another initiation. I work for a Hem/Onc practice and we bill for these pumps all the time. I hope this clarifies it for you.

[margie513]

Thank you so much, this really helps
Margie

[rross]

What do we do in the event the pump is deaccessed, then they are reaccessed.

We had a patient in yesterday who had a pump for 7 days, came in had it removed, went to see the physician for PEG tube removal, then returned for a pump to be put back on.