Health Information Management

Q/A: Correctly report port flush

APCs Insider, June 25, 2010

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Q: How can a hospital report a PICC line flush and dressing change when no infusion service is provided? Is a low-level clinic visit appropriate or should patients perform these services outside the hospital on their own? Noridian, our FI, doesn’t allow a clinic visit for these services because it believes patients can perform this service themselves.

A: You should report the code that most closely represents the service provided. CPT code 96523 (irrigation of implanted venous access device for drug delivery systems) for a port flush describes the service; you should report this code. The CPT parenthetical note states that this must be the only service provided on that date of service.

In the example provided, you should report 96523 rather than an E/M visit code because it most accurately describes the service provided and no other service was provided that day. Although this is the correct CPT code, the documentation also must reflect the medical necessity of the service and local coverage decisions may affect the coverage of the service.



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