Obtain the NHIA National Coding Standard for Home Infusion Claims under HIPAA at no charge from www.nhia.org for the National Definition of Per Diem, exact code descriptions, coding procedures and examples. Download the 2018 Quick Coding Reference here.
Per HIPAA regulation, providers and payers must use national standard codes and conform to HCPCS and CPT® code descriptions which may not be changed. HCPCS per diem S-codes have descriptions which (1) specify what is included in payment for the code and (2) by exclusion specify what is coded, billed, and paid for separately. An excerpt from a typical HCPCS description is:home therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
Per diem is coded and paid every day the patient is on service beginning with the day the therapy is initiated and ending with the day the therapy is permanently discontinued. See www.nhia.org/perdiemfinal.htm.
Use if required under provider-payer agreement, or to distinguish the provider’s charges for specialized high-tech home infusion nursing
All Services Provided in Infusion Suite
Modify per diem S-codes with –SS
Occasional Occurrence of Treatment in Infusion Suite
Do not modify per diem S-codes with –SS
Place of Service Code (POS)
May use 12=Home or 49=Independent Clinic
Provider should document health plan’s choice of POS
CPT® is a registered trademark of the American Medical Association.