Pump coding and billing issue

[Leon]

Question about how to handle billing when a patient returns due to a leaking chemo pump. The patient had an Adrucil pump started on 05/11, but called on 05/13 reporting it leaked overnight. THen came back in to complete the remaining 25mL of the infusion with a new CADD pump after confirming the original was visibly soiled and likely leaked at the OnGuard adapter connection. The pump was then replaced and the infusion restarted, with plans for disconnection at another facility. We billed them 95,416 on 05/11, but there was a confusion about whether we can bill it again on 05/13. Since this wasnt a new infusion, just finishing the original dose, I don't believe 95,416 or 95,521 are appropriatee. The only possible billing I see is maybe an E/M code, but Im not too sure since the visit was handled entirely by the infusion RN and not the oncology provider. Urgent help please.

 

[Billie.F]

Since it was the same dose being completed, you'd be stretching the rules to bill the chemo admin codes again and billing an E/M can be somehow unless your facility uses incident to rules creatively, which not all payers allow for infusion only encounters, I found this out a year ago and some places just document it as a nursing note and eat the cost if it's purely corrective.
That said, definitely document the pump failure and drug salvage clearly in the record if you want a potential reconsideration later if you try to submit anything.

 

[HAYABUSA]

Question about how to handle billing when a patient returns due to a leaking chemo pump. The patient had an Adrucil pump started on 05/11, but called on 05/13 reporting it leaked overnight. THen came back in to complete the remaining 25mL of the infusion with a new CADD pump after confirming the original was visibly soiled and likely leaked at the OnGuard adapter connection. The pump was then replaced and the infusion restarted, with plans for disconnection at another facility. We billed them 95,416 on 05/11, but there was a confusion about whether we can bill it again on 05/13. Since this wasnt a new infusion, just finishing the original dose, I don't believe 95,416 or 95,521 are appropriatee. The only possible billing I see is maybe an E/M code, but Im not too sure since the visit was handled entirely by the infusion RN and not the oncology provider. Urgent help please.

Since it's just a continuation, not a fresh start, rebilling will likely raise red flags. If no provider eval happened, E/M's probably off the table too. Agree with @Billie.F here for the most part.

 

[MedCodeNinja]

Totally get what you mean, it can be a challenge based on the payer and the policy. When it's just a quick fix like that, do you usually just note it down as a nursing note, or have you been able to get a reconsideration approved before?

 

[ClaimWizard]

Since it was the same dose being completed, you'd be stretching the rules to bill the chemo admin codes again and billing an E/M can be somehow unless your facility uses incident to rules creatively, which not all payers allow for infusion only encounters, I found this out a year ago and some places just document it as a nursing note and eat the cost if it's purely corrective.
That said, definitely document the pump failure and drug salvage clearly in the record if you want a potential reconsideration later if you try to submit anything.

It's a gray area, good point. Clear records on the pump and what to do are a must.

 

[ClaimCommander]

For sure, it's a bit of a gray area. Having clear and detailed documentation about the pump issue and the actions taken is crucial, it gives you a solid chance if you ever need to appeal down the road. I appreciate the insight