How To Use HCPCS Code B4197

HCPCS code B4197 describes the enteral feeding supply kit for syringe feeding, which is used on a daily basis. This code includes various components such as feeding/flushing syringe, administration set tubing, dressings, and tape. It falls under the category of parenteral and enteral nutrition and is used for billing purposes in medical coding and billing.

1. What is HCPCS B4197?

HCPCS code B4197 is specifically used to identify the enteral feeding supply kit for syringe feeding. It is important to note that this code is only applicable for syringe feeding and not for other methods of enteral feeding. The code is used to indicate the provision of necessary supplies for enteral feeding, including the syringe, administration set tubing, dressings, and tape.

2. Official Description

The official description of HCPCS code B4197 is “Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape.” The short description for this code is “Parenteral sol 74-100 gm pro.”

3. Procedure

1. Prepare the enteral feeding supply kit, ensuring that it includes a feeding/flushing syringe, administration set tubing, dressings, and tape.
2. Verify the patient’s enteral feeding requirements and ensure that syringe feeding is the appropriate method.
3. Administer the enteral feeding using the syringe and the provided supplies.
4. Monitor the patient during the feeding process and make any necessary adjustments.
5. Document the enteral feeding procedure in the patient’s medical record.

4. When to use HCPCS code B4197

HCPCS code B4197 should be used when providing enteral feeding supplies for syringe feeding on a daily basis. It is important to ensure that the patient’s enteral feeding needs are met and that syringe feeding is the appropriate method for their condition. This code should not be used for other methods of enteral feeding, such as tube feeding or gravity feeding.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code B4197, healthcare providers need to document the provision of the enteral feeding supply kit for syringe feeding. This includes documenting the use of the feeding/flushing syringe, administration set tubing, dressings, and tape. The documentation should clearly indicate the daily usage of these supplies for enteral feeding purposes.

6. Historical Information and Code Maintenance

HCPCS code B4197 was added to the Healthcare Common Procedure Coding System on January 01, 1988. It has been in use since then without any maintenance actions taken, as indicated by the action code N, which means no maintenance for this code. The code falls under the parenteral and enteral nutrition pricing indicator code 39, indicating that it is related to the pricing of parenteral and enteral nutrition supplies.

7. Medicare and Insurance Coverage

HCPCS code B4197 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. This means that the pricing for this code is determined by other factors, such as the specific reimbursement policies of Medicare and other insurers. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for further guidance on billing and coverage for HCPCS code B4197.

8. Examples

Here are five examples of when HCPCS code B4197 should be billed:

1. A patient with a medical condition that requires enteral feeding via syringe on a daily basis.
2. A healthcare facility providing enteral feeding supplies for a patient who is unable to consume food orally.
3. A home healthcare provider supplying enteral feeding kits for a patient receiving care at home.
4. A long-term care facility providing enteral feeding supplies for residents with specific dietary needs.
5. A hospice agency providing enteral feeding kits for terminally ill patients who require nutritional support.