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Answers to Compliance and Medical Coding Questions.
  1. Margaret Posted 6 Year(s) agoRelated Topics

    My general surgeon has asked me to find out whether or not it would be beneficial for them to begin billing out TPN or PEN on our patients, following global period, at their house. Is this billable from our standpoint??

    Any help would be greatly appreciated!

  2. SuperCoder Posted 6 Year(s) ago

    Prerequisites for both: Prior Authorization Required
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    TPN
    ===
    Submit all bills for home infusion on a CMS 1500 form, or its electronic equivalent.
    Enter the authorization number in Form Locator 23 on CMS 1500, or its electronic equivalent.
    When more than one date of service is submitted per claim form, itemize each date of service on a separate claim line in Form Locator 45.
    For each drug, enteral, or parenteral product, submit the appropriate HCPCS code in addition to the:
    -NDC number in 11-digit format
    -Product description
    -Dosage
    -Units administered
    -Frequency of administration
    -Duration of infusion (if applicable).
    For drugs, enter the drug units implicit in the NDC number (e.g. number of vials).
    Please Note: Use of only HCPCS “J” codes for drugs will deny for missing NDC number.
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    ENTERAL NUTRITION
    =================
    For enteral nutrition formulae, enter the number of cans in the units field.
    Please Note: Do not enter number of cases or the Red Book value listed in milligrams (ml) in the units’ field. Use of only HCPCS “B” codes for enteral/parenteral formulae, will deny for missing NDC number.
    *
    Per Diem rates do not apply to nutritional formulae taken orally. Reimbursement will be for the formulae, only.
    *
    When home nursing services are required for home infusion and specialty drug administration, bill using CPT 99601 for each nursing visit lasting up to two hours, in addition to CPT 99602 for nursing visits lasting more than two hours, with the applicable number of unit(s) for each additional hour.
    *
    When a member receives two or more concurrently administered therapies, append one of the modifier(s) listed below:
    Modifier -SH : Second concurrently administered infusion therapy
    Modifier -SJ : Third or more concurrently administered infusion therapy

  3. Margaret Posted 6 Year(s) ago

    Thanks Sanjit for your help. I never had to bill these out before. Your info is greatly appreciated. Would I use the S9364-59368 HCPCS codes? Would you know how to find out how much they would be paying or how I could find out what the RVUs are? Medicare doesn't give fees for the S codes.

  4. SuperCoder Posted 6 Year(s) ago

    As I have told earlier, the Key to reimbursement here, is : Preauthorization
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    Type -- procedure ------ 2011
    Service Code Fee
    =================================
    J S9365 $99.98
    6 S9365 $99.98
    J S9366 $144.05
    6 S9366 $144.05
    J S9367 $188.13
    6 S9367 $188.13
    J S9368 $44.08
    6 S9368 $44.08

  5. Margaret Posted 6 Year(s) ago

    Thanks Sanjit for your help! I truly appreciate it!

About this Question

  • Posted by 10878 Margaret, 6 Year(s) ago. There are 5 posts. The latest reply is from Margaret.