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Thread: heparin billing

  1. #1

    Question heparin billing

    AAPC: Back to School
    I need clarification. My company just did a revamp of our port access billing policy and it touched on heparin. The policy states heparin is not to be billed with 96523 (port irrigation) or 36591 (blood collection from VAD). It also states the 96523 can only be billed when it is the sole service for that date of service. It goes further to explain if any treatment is done that day, the 96523 is not billable because this maintenance function is an inherent part of accessing the VAD for treatment. But the heparin is being billed out even though the irrigation/flush is not. I believe neither heparin nor saline should be billed because they are components used in flushing prior to or after treatment. Am I right or wrong?
    From the Medicare National Correct Coding Initiative:
    “When vascular access is obtained, the access generally requires maintenance of an infusion or use of an anticoagulant (heparin lock injection)…These services are necessary for the maintenance of the access and are not to be separately reported. Additionally, the use of an anticoagulant for access maintenance cannot be separately reported…”

  2. #2

    Default MC

    Heparin is a supply, not an injection, but your statement may determine this not approprirate for MC patients, can you direct me to where you found your statement?

  3. #3

    Default heparin billing

    I pulled the quote from 2010 CSI Navigator for Freestanding Infusion Centers. It is a reference from Medicare's NCCI.
    So with J1642 being a supply (Hep-Lock), is it ever billable in an office setting - post infusion?

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