INFUSION THERAPY AND MEDICARE COVERAGE DETERMINATIONS
Infusion Therapy CPT and HCPCS Codes and Procedures
Finding an expert in Infusion therapy medical billing and coverage? It is important that an expert has experience auditing patient charts and claims and performing loss calculations for infusion billing disputes. The expert scope may include:
- hydration, therapeutic, prophylactic, diagnostic injections
- therapeutic or chemotherapy infusion
- local anesthesia, as part of the infusion process
- IV start and stop times with respect to audits and appropriate charges,
- access to catheter or port,
- flush, standard tubing, syringes, and supplies,
- drugs administered when infusion or injection commences, route of administration technique e.g., push, infusion, injection.
- Medicare guidelines, e.g., “For purposes of facility coding, an infusion is required to be more than 15 minutes for safe and effective administration. Hydration therapy is always secondary to infusion/injection therapy.”
Medicare Coverage Determinations (LCDs)
Opined regarding Medicare-covered conditions and the medical necessity of various procedures. When serving as an expert for the counsel for a criminal defendant, I survived a motion in Limine, Daubert challenge, and a motion for voir dire.
Motion to exclude DENIED – UNITED STATES of AMERICA v. Clifford Shoemake et al. CRIMINAL CASE NO. 16-00002. Order from the bench. Chief District Judge Frances Marie Tydingco-Gatewood of the U.S. DISTRICT COURT OF GUAM April 2018. Denied motion in Limine to exclude expert and motion for voir dire before trial. Arrigo’s opinions focused on assessing and rebutting the prosecution’s applications of methods, statistically invalid sample sizes, improper extrapolation, consistency in applying regulatory guidance, clinical documentation, medical diagnosis codes, procedure codes, application of criteria to Medicare coverage policies (i.e., Medicare Local Coverage Determinations (LCDs and Medicare definitions of ‘medically necessary.’)), identification of duplicated or missing data in an alleged $30 million Medicare fraud case. When Defendant’s opposition prevailed, the Government withdrew its Daubert challenge.
Experienced navigating, categorizing, and opinions on Medicare Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and Articles
- In Shoemake and other cases, part of the testimony and opinions focused on the precision or ambiguity of various coverage policies.
- For example, one billable infusion therapy code may have up to 16 various LCDs, NCDs, and Articles; some could be retired, some could be drafts, and some could be active or superseded.
Infusion Therapy Place of Service may be the home or other POS