Name of the Procedure:

Home Infusion Therapy, Continuous Anticoagulant Infusion Therapy (e.g., Heparin) | HCPCS Code: S9336

Summary

Home infusion therapy for continuous anticoagulant infusion involves the administration of medications like heparin directly into the bloodstream using a pump, conducted at a patient’s home. This service includes the essential administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment. The medications and nursing visits are coded separately and the service is billed on a per-diem basis.

Purpose

This procedure is designed to provide ongoing anticoagulant therapy to patients who need it for the prevention or treatment of blood clots. The main goal is to manage and maintain the desired level of blood thinning to prevent complications such as stroke, deep vein thrombosis (DVT), or pulmonary embolism (PE).

Indications

Patients who may benefit from this therapy include those with:

• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE)
• Atrial fibrillation with clot risk
• Mechanical heart valves
• Conditions requiring long-term anticoagulation management

Factors that make the procedure appropriate include the necessity for continuous anticoagulant management, the ability to self-manage or have caregiver support, and a suitable home environment for the therapy.

Preparation

Prior to starting home infusion therapy, patients may need:

• Blood tests such as Prothrombin Time (PT) and International Normalized Ratio (INR) to determine the baseline clotting status.
• Instructions on how to prepare the infusion site and maintain hygiene.
• Training on using the infusion pump and recognizing symptoms that require medical attention.

Procedure Description

1. A healthcare provider inserts a catheter into the patient's vein.
2. The infusion pump is set up to administer anticoagulant medication continuously at a prescribed rate.
3. The pump and infusion site are checked regularly by a healthcare professional.
4. Necessary supplies like the infusion pump, medication, tubing, and sterile dressings are provided.
5. The patient or caregiver receives training on how to manage the infusion system, including troubleshooting common issues.

No anesthesia or sedation is typically required for the insertion of the IV catheter or during the therapy.

Duration

The duration is continuous, with the infusion running 24/7, as long as the therapy is needed.

Setting

This therapy is performed at the patient’s home, making it convenient and comfortable for long-term treatment.

Personnel

• Home health nurses for IV setup, catheter care, and patient education.
• Pharmacists for medication management.
• Care coordinators to manage supplies and coordinate care among healthcare providers.

Risks and Complications

• Common risks: Localized infection at the catheter site, bruising, or bleeding.
• Rare risks: More serious infections such as sepsis, thrombosis at the catheter site. Complications are managed by contacting healthcare providers immediately for medical advice or intervention.

Benefits

• Helps prevent potentially life-threatening blood clots.
• Allows the patient to receive necessary treatment in the comfort of their home.
• Reduces the need for hospital visits, promoting convenience and cost-efficiency.

Recovery

• Patients receive ongoing support from healthcare providers.
• They are advised to monitor for any signs of complications and to maintain follow-up appointments as needed.
• Continuous treatment may require periodic blood tests to monitor effectiveness.

Alternatives

• Oral anticoagulants (e.g., warfarin, direct oral anticoagulants).
  • Pros: Easier to administer, no need for infusion equipment.
  • Cons: Requires consistent monitoring and adherence to dosing; may not be suitable for all patients.
• In-hospital or outpatient clinic-based therapy.
  • Pros: Controlled medical environment.
  • Cons: Less convenient, more frequent hospital visits, higher costs.

Patient Experience

Patients may feel a slight discomfort or insertion pain at the infusion site initially. Over time, most report minimal discomfort as they adjust to the infusion routine. Pain management includes regular site care and analgesics if necessary. Comfort measures include using sterile techniques and keeping supplies close at hand to minimize disruption to daily life.