Must providers and payers break out coding for home infusion nursing visits? Or, could they agree to include some home nursing as part of the per diem when the HCPCS per diem “S” codes are used?
Under HIPAA rule, providers, payers and clearinghouses may not change the meanings of HCPCS or CPT descriptions within an electronic claim. See the FAQ on the relevant regulations. Therefore, because most of the HCPCS per diem “S” codes for home infusion therapy specify “drugs and nursing visits coded separately”, home infusion nurse visits cannot be included in the per diem. To do otherwise would be an enforceable violation of HIPAA law. Thus, nursing visits are coded and paid for separately.
