Quick Code Reference

Introduction

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.

Home Infusion Therapy Per Diem Codes

S9497
Q3 hours
S9504
Q4 hours
S9503
Q6 hours
S9502
Q8 hours
S9501
Q12 hours
S9500
Q24 hours
S9494
Unspecified
S9330
Cont. ( ≥ 24 hrs )
S9331
Intrmnt. ( < 24 hrs)
S9329
Unspecified
S9343
Bolus
S9341
Gravity
S9342
Pump
S9340
Unspecified
S9374
1.0 liter/day
S9375
>1.0-2.0 liters/day
S9376
>2.0-3.0 liters/day
S9377
>3.0 liters/day
S9373
Unspecified
S9326
Cont. ( ≥24 hrs )
S9327
Intrmnt. (<24 hrs)
S9328
Implanted pump
S9325
Unspecified
S9365
1.0 liter/day
S9366
>1.0-2.0 liters/day
S9367
>2.0-3.0 liters/day
S9368
>3.0 liters/day
S9364
Unspecified
S5498
Single lumen
S5501
>1 lumen
S5502
Implanted access
S5497
Unspecified
S5517
Declot supply kit
S5518
Repair supply kit
Use when catheter care provided as a standalone therapy, or during days not covered under per diem by another therapy. (Not Per Diem) Supplies required for non-routine catheter procedures are coded and paid separately from other per diem S-codes
S9379
Infusion
S9542
Injectable
Use only for misc. therapies not otherwise described by more specific per diem S-codes
SS
Service in infusion suite of home infusion provider
SH
2nd concurrent ther.
SJ
≥3rd concurrent ther.
Use if needed to distinguish per diem rates per provider-payer agreement, to distinguish the provider’s usual and customary fees, or to indicate that the therapy is a distinct administered therapy.
JA
Administered IV
JB
Administered subq
TG
Complex/high level of care
S9061
Aerosolized drug (e.g. pentamidine)
S9346
Alpha-1-proteinase inhibitor (e.g. Prolastin®) – infusion
S9336
Anticoagulant (e.g. heparin) – cont. infusion
S9372
Anticoagulant (e.g. heparin) – intrmnt. inj.
S9351
Anti-emetic – cont. or intrmnt. infusion
S9370
Anti-emetic – intrmnt. inj.
S9345
Anti-hemophilic agent (e.g. Factor VIII) – infusion
S9363
Anti-spasmotic – infusion
S9359
Anti-tumor necrosis factor intravenous (e.g. infliximab) – infusion
S9538
Blood product(s) transfusion. Blood products coded and paid separately
S9355
Chelation – infusion
S9490
Corticosteriod – infusion
S9361
Diuretic intravenous – infusion
S9357
Enzyme replacement intravenous (e.g. imiglucerase) – infusion
S9558
Growth hormone – injectable
S9537
Hematopoietic hormone (e.g. erythropoietin, G-CSF, GM-CSF) – inj.
S9560
Hormonal (e.g. leuprolide, goserelin) – injectable
S9338
Immunotherapy (e.g. immunoglobulin) – infusion
S9348
Inotropic/ sympathomimetic (e.g. dobutamine) – infusion
S9353
Insulin – cont. infusion
S9559
Interferon – injectable
S9590
Irrigation (e.g., of an organ or anatomical cavity) – injectable
S9562
Palivizumab (e.g. Synagis®) – injectable
S9339
Peritoneal dialysis
S9349
Tocolytic – infusion
S9347
Uninterrupted, long-term, controlled rate (e.g. epoprostenol) – intravenous or subcutaneous infusion
HCPCS
Use specific HCPCS drug codes (“j-codes”) with NDC number
99601
Home infusion/specialty drug administration, per visit (up to 2 hrs)
99602
each additional hour Include time for all nursing activities of a nurse visit: preparation, travel, time in the home, documentation, post-visit reporting, follow-up activities, etc.
S5522
PICC line insertion (supplies/catheter excluded)
S5520
PICC line kit
S5523
Midline insertion (supplies/catheter excluded)
S5521
Midline kit Coded and paid separately from 99601 and 99602, as well as separately from any other per diem S-code. Modify with –SS if insertion performed in infusion suite. Modifiers
SS
Service in infusion suite of home infusion provider Time recorded is for duration of patient service in suite
SD
Specialized, highly technical

Use if required under provider-payer agreement, or to distinguish the provider’s charges for specialized high-tech home infusion nursing

SS
Service in infusion suite of home infusion provider

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

POS

Place of Service Code (POS)
May use 12=Home or 49=Independent Clinic
Provider should document health plan’s choice of POS

S9810
Professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour Include time for all activities of a professional pharmacy service: applicable travel, clinical cognitive activities, care coordination activities, compounding, packaging, documentation, etc., in the office or home Do not use if a per diem S-code is also used that includes professional pharmacy services
99050
In the office at times other than regularly scheduled office hours
99051
In the office during regularly scheduled evening, weekend, or holiday office hours
99053
Between 10:00 PM and 8:00 AM at 24-hour facility Use per provider-payer agreement or to distinguish provider's charges. One or more of these codes are used to charge for after hours occurrences.
S9381
High risk/escort delivery or service, per visit
S0315
Disease management program, initial assessment and initiation
S0316
Disease management program, follow-up/reassessment
S0317
Disease management program, per diem
S0320
Disease management program, RN telephone calls, per month
S9470
Nutritional counseling, dietitian visit
S5036
Infusion device repair (e.g. pump repair)
S5035
Infusion device routine service (e.g. pump maint.)
S9470
Nutritional counseling, dietitian visit
99056
Provided out of the office at request of patient
99058
Provided on an emergency basis in the office
99060
Provided on an emergency basis, out of the office
99082
Unusual travel Coded and paid separately from other per diem S-codes

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