Total Parenteral Nutrition and Enteral Nutrition in the Home. Original Policy Date 12:2013

Transcription

1 MP Total Parenteral Nutrition and Enteral Nutrition in the Home Medical Policy Section Durable Medical Equipment Issue Original Policy Date Last Review Status/Date Return to Medical Policy Index Disclaimer Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically. Description Total parenteral nutrition (TPN), also known as parenteral hyperalimentation, is used for patients with medical conditions that impair gastrointestinal absorption to a degree incompatible with life. It is also used for variable periods of time to bolster the nutritional status of severely malnourished patients with medical or surgical conditions and who are unable to benefit from enteral nutritional supplements. TPN involves either peripheral vein catheterization (short-term) or percutaneous transvenous implantation of a central venous catheter (long-term) into the vena cava or right atrium. A nutritionally adequate, sterile, hypertonic solution consisting of glucose (sugar), amino acids (protein), electrolytes (sodium, potassium), vitamins and minerals, and sometimes fats, is administered daily. An infusion pump is generally used to assure a steady flow of the solution on either a continuous (24-hour) or intermittent schedule. If intermittent, a heparin lock device and diluted heparin are used to prevent clotting inside the catheter. Enteral nutrition (EN) is used for patients with functioning intestinal tracts, but with disorders of the pharynx, esophagus, or stomach that prevent nutrients from reaching the absorbing surfaces in the small intestine. EN involves administering non-sterile liquids directly into the gastrointestinal tract through nasogastric, gastrostomy, or jejunostomy tubes. An infusion pump may be used to assist the flow of liquids. Feedings may be either intermittent or continuous (infused 24 hours a day). Policy The following criteria must be met prior to the initial implementation of enteral/parenteral services. In qualifying conditions where enteral nutrition appears appropriate, an attempt must be made to meet the patient's need by enteral nutrition prior to implementing TPN. PARENTERAL/TOTAL PARENTERAL NUTRITION (TPN) TPN may be considered medically necessary in the treatment of conditions resulting in

2 impaired intestinal absorption or in obstruction of the GI tract, including but not limited to, any of the following conditions: obstruction of the small or large bowel; short bowel syndrome secondary to extensive small bowel resection; acute pancreatitis of greater than one week's duration; malabsorption due to enterocolic, enterovesical, or enterocutaneous fistulas (TPN being temporary until the fistula is repaired); newborn infants with catastrophic gastrointestinal anomalies such as tracheoesophageal fistula, gastroschisis, omphalocele, or massive intestinal atresia; infants and young children who fail to gain weight due to systemic disease or intestinal insufficiency associated with short bowel syndrome, malabsorption, or chronic idiopathic diarrhea; or patients with prolonged paralytic ileus following major surgery or multiple injuries. TPN may also be considered medically necessary for the following conditions: patients who have failed to thrive while receiving enteral nutrition; anorexic or bulimic patients whose specific physical abnormalities or weight loss have not stabilized and moved towards correction by enteral nutrition, and who are severely underweight, malnourished or losing weight at a rate that will likely lead to serious medical sequelae. TPN would be used only for the time necessary to stabilize those abnormalities and begin correction. At that time, either enteral nutrition or, if possible, resumption of oral intake is indicated; severe hyperemesis gravidarum; or during chemotherapy, when patients cannot maintain adequate nutrition due to nausea, vomiting or diarrhea. When TPN is used during chemotherapy, the criteria in the policy guidelines do not need to be met. Rationale 2010 Update A literature search for the period of May 2009 through February 2010 did not identify any studies that would alter the current policy statement on enteral and parenteral nutrition. However, the statement on oral nutrition has now been restricted to only those patients with inborn errors of metabolism, clarifying member contract exclusions. Codes Number Description CPT Placement of central venous catheter code

3 range 36580, 36581, 36582, 36583, 36584, Replacement of central venous catheter code range Percutaneous placement of gastrostomy tube ICD-9 Procedure Tube or needle catheter jejunostomy for enteral alimentation, intra-operative, any method Venous catheterization, not elsewhere classified Insertion of totally implantable vascular access device Enteral infusion of concentrated nutritional substances Parenteral infusion of concentrated nutritional substances ICD-9 Diagnosis Malignant neoplasm of esophagus code range Secondary malignant neoplasm of other digestive organ Benign neoplasm of esophagus Carcinoma in situ of esophagus Carcinoma in situ of stomach Neoplasm of uncertain behaviour of stomach, intestines, and rectum Neoplasm of uncertain behavior of unspecified digestive organs Neoplasm of unspecified nature of digestive system Malignant neoplasm of stomach code range Secondary malignant neoplasm of other digestive organ Neoplasm unspecified nature digestive system Stricture and stenosis of esophagus

4 Other specified disorders of stomach and duodenum Crohn s disease code range Acute vascular insufficiency of intestine Postgastrectomy syndrome Other specified functional disorders of intestine Fistula of intestine, excluding rectum and anus Other and unspecified postsurgical nonabsorption Other specified intestinal malabsorption Intestinovesical fistula Tracheoesophageal fistula, esophageal atresia and stenosis Other specified anomalies of stomach Atresia and stenosis of small intestine Atresia and stenosis of large intestine, rectum, and anal canal Anomalies of abdominal wall Dysphagia HCPCS B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4157, B4158, B4159, B4160, B4161, B4162 Diarrhea (the policy states chronic idiopathic diarrhea ; there is no other code for this) Digestive system complication (*this code should be accompanied by a code to identify the specific condition) Enteral formulae code range B4164, B4168, B4172, Parenteral solution code range

5 B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4216, B4220, B4222, B4224, B5000, B5100, B5200 B9000 B9002 B9004 B9006 E9998 E9999 S9364,S9365, S9366, S9367, S9368 S9340, S9341, S9342, S9343 Enteral nutrition infusion pump code range Parenteral nutrition infusion pump code range NOC for enteral supplies NOC for parenteral supplies Home infusion therapy, total parenteral nutrition, per diem code range Home therapy, enteral nutrition, per diem code range Type of Service Place of Service DME and Supplies Home Index Enteral Nutrition (EN), Home Home Infusion Therapy (Hyperalimentation), Home Hyperalimentation, Home Parenteral Nutrition, Home Total Parenteral Nutrition (TPN) and Enteral Nutrition (EN), Home TPN (Total Parenteral Nutrition), Home