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Pump Billing

  1. #1
    Default Pump Billing
    Medical Coding Books
    Please let me know how I would code this patient.

    Patient arrives for a Chemotherapy Initial Infusion with the same medication
    being billed over 2 hours time. The nurse hook up the chemo pump on the same date and the patient returns home and is continually infused with the pump for 3 days. The patient arrives back at the clinic on day 4 and the pump is refilled for 2 additional days of chemo?

    Also, how would it be coded if the pump was removed on day 4?


  2. Default
    Since the nurse hooks up, the return visit service is alone billable I suppose - which is on day 4 for pump refill and for 2 additional days of chemo.


  3. Cool Pump Billing
    To answer your question about how you would code pump removal on day 4. If the only service on day 4 is pump removal, then 99211 is the code to use.

    If a patient receives chemo and is sent home with a filled pump for a couple of days with the same medication, you would code (for example) the 2-hour infusion in the infusion suite and then 96521 for the filling of that pump. If they return on day 4 and the pump is again refilled, you would again use 96521.

    You would not be able to capture the days the patient is receiving chemo via the pump since you already captured the charge when you filled the pump.
    Last edited by AuntJoyce; 11-19-2009 at 06:21 AM. Reason: Incomplete reply sent

  4. #4
    I would bill a 96413, 96415 (providing the second hour is 31min or greater) and a 96416 on day 1. Then when pt returns for their ump disconnect I would bill the 96521 on that day (day 4?). Good luck!

  5. Default 5fu
    I have recently received a denial of the IVP of 5FU given same day as pump hookup. The reason is only one admin of this drug per day. (How do they know what drug is going in the pump?) Can anyone provide documentation to support the correct way of billing this?

  6. Default
    Add the two 5Fu's together and only bill once

  7. Default Pump Billing...
    It would not be appropriate on the day the pump is being discontinued to code for administration of any residual left in the pump from previous administrations/fillings.

    It is appropriate to bill for a short push on the same day as refilling the pump - you would not be getting proper reimbursement if you simply add the amounts together. It is not considered 2 administrations of the same drug when you give a short push and then refill a pump since the medication in the pump will not be administered during that session.

    Infusion coding can get very complicated and is probably the most misunderstood practice...

  8. Cool
    so if the patient has a pump and i bill 96416 59 with J9190 and then the patient, while in the office, has J9190 via 96411, the insurance company will pay for the J9190 two times??

  9. #9
    On the first day you would bill a 96411, 96416 and the loading dose (given in the office) of the 5FU. The remaining 5FU (given in the pump) would be billed to DMERC (durable medical equipment). So let's say the patient got 13 units, 2u in the office and 11u in the pump, bill to Medicare 2u and DMERC 13u.
    Day 4 if the patient had more 5FU put in the pump then you could bill a 96521, if you disconnected the pump then either a 99211 or 96523 (declotting of vad).
    Hope this helps!

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