Infusion Pump Billing

Hello,

We do approx 50 to 60 5fu infusion with FOLFOX in a month, we thought it might be advantageous to own pump and bill for that service.

Can anybody give us a test example of how billing would actually happen using a Medicare patient for example :

If patient gets 5fu 4800 mgs over 48 hours which cpt code we need to use and how much Medicare will reimburse?

And under current scenerio where we have third party provide the pump and offcourse they bill for the actual pump and we bill for pump refill etc. We need side by side comparison so that we can make a decison whether to buy the pumps Or continue to use third party.

Thanks in advance,

Brian

Infusion Pump Billing

This is an interesting and complex question, and probably will require you to hire a consultant to do the analysis for you. Perhaps someone in the Codapedia community can refer someone with this specific knowledge to you. Or, perhaps, someone knows of a resource.

We hope that Codapedia will be a combination of an encyclopedia of coding articles, contributed by coders, doctors, managers and consultants and a forum for questions. Anyone can post an article in their area of expertise, and ask and answer questions. When a question is asked and I know there's an answer, I link to it. If there is an article, but it doesn't answer the question (like the one on G codes and e-prescribing today) I update the article so it will be more useful in the future.

The think I like about listserv's is the sense of community, and the quick response from members. But, they are often hard to search, with the information spread among many different answers. I hope that Codapedia as a forum can improve upon that.

In the near future, I will take some of the longer Q&A answers, and put them into article format.

Thanks to all who are participating.

Infusion Pump billing

Hello-

We do pump billing as well.... once a month we charge a pump rental fee code E0781, which you can only bill every 30days. In the meantime we bill it as a pump refill 96521 and home supplies A4222 and home infusion pump initiation 96416

Follow up question

Tracic271
When you bill to the insurance companies other than Medicare do you add modifiers to the refill code and supply code? We are receiving denials for them being included in the procedure.