(December 21, 2011)

NHIA is pleased to announce that the 2012 version of the NHIA National Coding Standard for Home Infusion Claims under HIPAA is now available and still offered to the public at no charge.  First published in 2002, this document of procedures and examples for coding home infusion claims is widely used by payers and providers throughout the United States.  NHIA’s consistent, annual updates to this crucial National Coding Standard represent a strategic effort by NHIA to actively advance standardization of claim transactions and coding for all home infusion services provided.

The publication presents the HCPCS (Healthcare Common Procedure Coding System) per diem "S” codes as a comprehensive coding system for home infusion therapy claims and provides procedures for their use, information about what's included in the home infusion per diem, and detailed coding examples for both typical and unusual claims scenarios that payers and providers are likely to encounter.   It also includes procedures and examples for services provided in the Ambulatory Infusion Suite of the Home Infusion Therapy Provider (AIS).

As compared to the 2011 version, the 2012 National Coding Standard provides new guidance on the use of the concurrent therapy modifiers (-SH and -SJ) and on specificity of coding with HCPCS per diem "S" codes.  These changes are further explained below.

• Download Latest NHIA National Coding Standard, v1.11.01a (free, registration required.)

• About NHIA's Quick Coding Reference for Home Infusion Therapy.

• Visit the HIEC Resource Center.

A summary of the changes to the National Coding Standard follows.

Additional Use for Modifiers -SH and -SJ

In the past, we have instructed that modifiers -SH and -SJ would be situationally used to specify occurrences of second, third or more therapies provided on the same dates of service only if such distinction is needed per provider-payer agreement on per diem rate or to distinguish the provider’s usual and customary fees. We have been informed some payers need a coding structure for providers to indicate that per diems billed on the same dates of service are all distinct administered therapies. As a result, we now specify that -SH and -SJ may also be used to indicate that 2nd, 3rd, etc. per diems that are billed on the same dates of service are distinct administered therapies not to be denied as duplicate billing.

Selection of Specific Per Diem “S” Code

We have added that billers should exercise care to select “S” codes that best describe the specific drug therapies provided. If a per diem “S” code description very specifically describes a drug therapy, it would normally be inappropriate to use a more generally described “S” code. For example, when solumedrol is infused then S9490 (corticosteroid infusion) best describes the therapy and it would not normally be appropriate to use a less specific code such as S9347 (uninterrupted, long-term, controlled rate.) Billers should be aware of any terms in provider-payer agreements (contracts) that could further specify the “S” code to be billed.