Documentation
Precertification is not required for Home Inotropic Infusion Therapy. Documentation supporting the medical necessity should be legible and maintained in the patient's medical record and made available to HMSA upon request. HMSA reserves the right to perform retrospective review using the above criteria to validate if services rendered met payment determination criteria.
The following documentation should appear in the patient's medical record. This information should be included with precertification requests:
- Physician's orders, including drug regimen(s), name of the drug, concentration, volume, infusion rate and duration (start and end dates)
- ICD-9-CM/ICD-10-CM diagnosis code
- Clinical information regarding the primary diagnosis
- Clinical information regarding the rationale for ordering inotropic infusion therapy
Claims Filing Information
Please use the codes listed below when submitting claims for inotropic therapy.
| Code | Description |
| S9348 | Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g., Dobutamine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
*This code will require clinical notes until 1/1/2021. |
| 99601, 99602 | Nursing care |
Billing drugs administered
Identify the drug administered using the specific HCPCS code when available. Use the unlisted HCPC code (J3490) and NDC number only when a specific HCPC code is not available.
Nursing services (CPT codes 99601 and 99602) are covered and do not require precertification. Nursing services may be billed separately and are not included in the per diem for IV therapy.
Example
The patient suffers from CHF. The attending physician has ordered an infusion of dobutamine HCl at 10 mcg/kg/min for one month. The patient weighs 70 kilograms.
The provider should bill the per diem charge on the first service line.
S9348 x 31 units
A nursing visit on the first day should be billed on the second line.
99601 x 1 unit
Nursing visits during the second, third and fourth weeks of therapy should be billed on subsequent lines as needed. For example, on day 29, a problem developed with the infusion line and a nursing care visit was required. A second nursing care visit was required on October 30, due to continuing problems with the line.
Because there are so many services to be billed, two claim forms were used. When this occurs, please follow the directions shown in Multi - page Claims. The claim should be completed as follows:
Drug Unit Calculations
The unit calculations for this drug are complex. We suggest that the billing clerk ask the pharmacist to calculate the units in such a case.
The patient is receiving 10 mcg/kg/min. To calculate the units in such a case, first determine the exact dosage. The dose (10 micrograms) is then multiplied by the patient's weight (70 kilograms). The patient is receiving 700 micrograms per minute, or 42,000 micrograms per hour. In 24 hours the patient will receive 1,008,000 micrograms, or 1,008 milligrams. Over the course of 31 days, the patient will have received 31,248 milligrams of medication.
The drug concentration is 12.5 mg/mL. To convert milligrams into milliliters divide 31,248 by 12.5. The quotient, 2,500 milliliters, is the amount of medication that will have been received by the patient during the month.
J3490 NDC: 00002-7175-10 x 2500 units
For more information, please refer to the Home Continuous Inotropic Infusion Therapy medical policy.
