Health Information Management

Q/A: Infusions in multilumen catheters

APCs Insider, October 2, 2009

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Q: How should we assign CPT codes for an infusion of desferal at the same time as blood products, such as platelets or red blood cells (RBC)? The patient has a double lumen catheter. The physician order states: give desferal 2 gm IV with each unit of RBC. The blood is run over two hours. The nurse hooks up the desferal in one lumen, hooks the unit of RBC in the other lumen, and runs them at the same time.
CCI edits state that CPT codes 96365 (Intravenous infusion for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to one hour) and 96366 (Intravenous infusion for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, each additional hour) edits with 36430 (Transfusion, blood or blood components). The edits for modifier -59 ask if this is separate sites/sessions. The nursing staff states that it is two separate sites because patient has two lumens so the code could be modified.
Does a multilumen catheter fit the criteria for two separate sites? Should we consider the desferal non-chemotherapy infusion concurrent to the blood or an initial and additional non-chemotherapy infusion?
I have searched various places and cannot find a definite answer. Because the blood transfusion code 36430 does not fall under non-chemotherapy infusion diagnostic therapeutic fluids/substance/drug CPT codes I am not coding it as concurrent.

A: The nursing department considers a double lumen catheter to be two separate sites because from its clinical perspective, the lumens are separate and the exit portals are at individual locations along the length of the entire catheter. However, clinical perspectives are not relevant to coding guidelines in this scenario. CPT Assistant, May 2007, states that a double lumen catheter is a single access site.

An example of a concurrent infusion involves the use of a mult.lumen catheter, a single catheter with more than one internal line (lumen). Each lumen is connected to a different intravenous infusion (bag) with the fluids exiting at different points along the catheter. These allow several different infusion solutions to run with only on vein access site.
Regardless of the number of lumens or the number of infusions administered via these lumens, there is one access site.
Blood transfusion services are not part of the CPT drug administration hierarchy and should be reported once per encounter. Because a blood transfusion is not part of the hierarchy, reporting the desferal as a concurrent infusion is incorrect coding because no initial service is reported. An NCCI edit exists for code pair 36430 and 96365; 36430 is the comprehensive code. Based on documentation in the record, modifier -59 could be appropriate if the infusion is separate and distinct from the blood transfusion. If they are separate and distinct, you may append modifier -59 to 96365 to denote this.
The CPT Manual defines modifier -59 as:
Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual…

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