Administration of Fluid and/or TPN via CADD
At our pediatric oncology hospital, often hydrating fluids are ordered and administered via a CADD pump for at least 24 hours prior to the administration of certain chemo meds. Since C8957 is defined as Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than 8 hours), requiring use of portable or implantable pump is it appropriate to code/charge C8957 for fluids given via CADD? It is being used to prevent nephrotoxicity and/or assist with patients who have nausea and vomiting to prevent dehydration. Since the fluids are connected to a pump that the patient leaves with , there is a start time but no stop time. I understand that 96360 and 96361 is not appropriate but was wondering about C8957.
In addition, for patients that are having to receive TPN, can C8957 be used for their administrations as well?
Comments
According to Coding Clinic for HCPCS, this is not an appropriate code for prolonged hydration.
"Administration of Hydration Via Pump
Coding Clinic for HCPCS, Third Quarter 2008 Page: 8
Coding advice contained in this issue is effective with procedures/services provided after October 15, 2008 unless otherwise noted.
QUESTION 6
The code descriptor for HCPCS code C8957, Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than eight hours), requiring use of portable or implantable pump, specifically states infusion for "therapy/diagnosis."
If a patient is given more than 8 hours of hydration via a portable or implantable pump, is it appropriate to report HCPCS code C8957?
Is hydration considered a type of infusion for therapy/diagnosis? If not, how should 8 or more hours of hydration via a pump be reported?
ANSWER
It would be inappropriate to report HCPCS code C8957, Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than eight hours), requiring use of portable or implantable pump, for the administration of hydration.
Hydration services are appropriately reported with CPT code 90760, Intravenous infusion, hydration; initial, 31 minutes to 1 hour, and CPT code 90761, Intravenous infusion, hydration; each additional hour, even if administered via a pump."
I don't see any reason that you couldn't use this for TPN for outpatients as it is a therapeutic infusion and the code is reported one time. I would recommend documentation of either when the infusion ends, the cassette/reservoir is changed, etc., to support that the infusion was prolonged. For inpatients, it would typically replace their meals/nutrition source and would be included in the room rate.