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HCPCS - CPT CODES (K. Kokotis)

Since many people are asking questions regarding codes for this and that, I wanted to start a separate discussion.
I work in an acute care facility that has an outpatient infusion center. They are looking at lack of codes, currect codes, etc. to accurately capture billing for services.

Midline - we have found no code. Would you use CPT 36410 which describes a venipuncture; soft flexible cathteter for the use of blood draw or infusions?
There is a code for Home Infusion - all supplies including catheter for a midline insertion S5521. And then a Home Infusion - insertion of a midline catheter (nursing services only) S5523.

So why is there no code for areas outside of the home? This doesn't make sense to me.

Biopatch - HCPCS A6209 describes a foam dressing?

Stat-lock - HCPCS A5200 describes a percutaneous catheter anchoring device?

Central line dressing change - no CPT code (? 375012 SIM code)

Appreciate any assistance with verification regarding these codes. Anyone with coding/clinical experience.

Some things in life are not free

Hospital outpatient: Many things are bundled like periphreal IV's etc. There is no code for a PIV or a midline for Medicare (hospital). The reason is they are bundled or free. The code you found was for blood draws with a peripheral IV it is not infusion with a peripheral IV. Dressing change kits are also free and part of the visit.

For Home care there is zero Medicare reimbursement in the home for infusion drugs unless they are on the magic list: Ganciclovir, foscarnet, ampho B and some TPN. The codes for midline you found are to give those non-midline drugs. Drugs are not paid for in the home nor the supplies to administer the drugs however the nursing visit to give the non paid drugs and supplies are paid for by Medicare

Hope that answers your questions


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