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Portable pump initiation/refill

  1. #1
    Question Portable pump initiation/refill
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    I am having some trouble with portable pump initiation vs. refill. I have a patient that comes in twice a week for 5FU. I have all of the administration figured out, the problem we are having is that pt comes in on day 1 gets an infusion then pump is filled and is connected to patient. Patient then comes in the next day and has the pump disconnected. Then the patinet returns three days later and gets the same treatment (infusion, then reconnected to the pump). CSI says that code 96416 can only be billed once per treatment cycle. Is the cycle the scheduled (plan). i.e. twice a week for three months or is the cycle each treatment?
    It just seems like overbilling to do a pump initiation (96416) and then the disconnect (99211) twice a week for who knows how long.
    Please advise.

  2. #2
    Overland Park Kansas
    Ok, say the treatment plan/regimen is for 6 cycles every other day. The first day of cycle 1 would be coded as the initiation of the pump 96416. Every time the patient comes back for the refill of the 5FU of the pump you would bill 96521 Refill of portable pump. Once the patient finishes the 6th cycle that treatment plan/regimen is complete. If the physician decides that more treatments is needed and has another plan/regimen then you would bill 96416 for the first day of the cycle and 96521 for the remainding days the pump is being used.

  3. Default
    I have a similar question to the above referenced ones. I have a patient who had a pump yesterday 9/27, so we used 96416. Patient is coming in tomorrow 9/29 for disconnect. Can I use 96521 tomorrow along with an office visit or just omit the office visit and soley use 96521 for the disconnect?? Please help. I am a bit confused

  4. #4
    I agree w/ daisy3663. This is my understanding as well.
    Kiana CPC, CPC-H, BCS-M, BCS-R

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