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Get Appropriate Reimbursement For Port Flush

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By Author: Dev SuperCoder
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Oncology practice billing staffs often wrongly assume that the pump and venous access port are one and the same. Although both are integral parts in the infusion technique and ports must be flushed with heparin routinely to prevent clotting to guarantee proper pump function, Medicare considers them separate. Maintenance of a venous port should not be confused with the flushing of the implantable infusion pump, but there are billing options.

Some oncology practices mistakenly are using 96530 (refilling and maintenance of implantable pump or reservoir) to bill for the flushing and accessing of ports used during and after chemotherapy. According to Medicare guidelines and oncology coding experts, 96530 would lead to overpayment for a service that routinely is performed by a nurse without physician supervision.

Most of the time you cant bill for the procedure, says Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a Dallas, Ga.-based coding consulting firm.

Its never an acceptable charge if it is done in conjunction with chemotherapy, says Elaine ...
... Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology, an oncology practice in Hooksett, N.H.

Medicare policy on using 96530 is clear as well. According to Medicare, the accessing and flushing of the implanted infusion pump and its attached catheter either in a large vein, the epidural or subarachnoid space is included in an appropriate evaluation and management (E/M) service code as part of managing the patient. In addition, CPT code 99211 (office or other outpatient visit) for accessing and flushing of a catheter, line or port, when the service is distinct and separate from chemotherapy administration and other E/M services.

Use of 99211 depends on whether the flushing of the port is a separate and distinct service. In other words, the maintenance of the port is not part of chemotherapy treatment or a higher-level E/M visit in which the physician is present and the criteria of an E/M visit are met. Instead, oncology practices should bill the higher-level visit, 99212-99215, and consider the port flush as part of the office visit.

As an example of the different ways carriers require oncology practices to bill for port flushes, the following information is taken from the local medical review policies (LMRPs) of two carriers:

Blue Cross Blue Shield of Montana

Using venous access devices for blood collection and/or Heparin flush for any reason is part of managing the patient with this type of long-term venous device. It is included in the appropriate CPT coding guidelines. E/M service codes should not be upcoded to specifically indicate that blood collection or flushing was performed in addition to other services.

2. The HCPCS code J1640 may be billed for the cost of Heparin if used when flushing.

Wisconsin Physicians Service Co.

Flushing of a vascular access port prior to administration of chemotherapy, or other medically necessary drug administration, is integral to the drug administration and is not billable separately, this carrier states. If a special visit is made to a physicians office just for the port flushing, code 99211 should be used. Code 96530, while a payable service, should not be used to report port flushing.

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