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Report 96523 for port flush

APCs Insider, October 6, 2006

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Report 96523 for port flush

QUESTION: What is the correct code to assign when a Medicare patient presents to the outpatient infusion unit for a port flush? If this is the only service that nursing provides, can we assign an E/M code?

ANSWER: Report CPT code 96523 (irrigation of implanted venous access device for drug delivery systems) for the irrigation. For 2006, this code has a status indicator N (packaged service) and generates no separate APC payment.

There has been much discussion over the last several years regarding whether it is appropriate to also assign an E/M level when the only service provided is a packaged service. CMS has also made conflicting statements on this issue. You can find the latest guidance published on August 23, 2006: http://www.cms.hhs.gov/HospitalOutpatientPPS/Downloads/CMS1506P.pdf.

In the discussion of packaged codes, CMS proposes to make several codes (including 96523) "special" packaged codes that will receive an APC payment when billed on a claim with no other separately payable OPPS service for the same date of service.

CMS also discusses billing these packaged codes. They remark that, "While we have been told that some hospitals may bill for a low-level visit if a packaged service only is provided so that they receive some payment for the encounter, we note that providers should bill a low-level visit code in such circumstances only if the hospital provides a significant, separately identifiable, low-level visit in association with the packaged service."

We believe that this statement answers your question. For 2007, if CMS does implement the "special" packaged codes as proposed, providers will not need to report an E/M code for reimbursement.

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