Is each lumen in a multi-lumen catheter billed separately?

Q: We are having a heated internal discussion regarding reporting drug infusion charges when a multi-lumen catheter is being used. Nursing wants to charge for both lumens as if they were a separate line because they are hanging different medications and fluids through each one. When we tried this on a claim, the edits were either saying we needed to append a modifier for one of the initial hours of service or we hit the medically unlikely edit because of too many units. How is this supposed to be reported?

A: A multi-lumen catheter, like a triple lumen subclavian catheter or a dual-lumen jugular catheter, is considered one IV site, so the reporting of the drug administration services should be based on that concept. There are multiple infusion ports in the catheter itself, which allow different medications and substances to be infused through each lumen as if each lumen were a single line. However, the drug administration coding guidelines in the CPT Manual and in the NCCI Manual note that the services are reported “per IV site.”

According to chapter 11 of the NCCI Manual:

If both lumina of a double lumen catheter are utilized for infusions of different substances or drugs, only one “initial” infusion CPT code may be reported. The double lumen catheter permits intravenous access through a single vascular site. Thus, it would not be correct to report two “initial” infusion CPT codes, one for each lumen of the catheter.

The CPT guidelines state:

When administering multiple infusions, injections or combinations, only one "initial" service code should be reported for a given date, unless protocol requires that two separate IV sites must be used. Do not report a second initial service on the same date due to an intravenous line requiring a re-start, an IV rate not being able to be reached without two lines, or for accessing a port of a multi-lumen catheter.

The drug administration services should be reported just as they would be for any single IV site, using the sequential and concurrent infusion concepts.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.