Home infusion therapy, total parenteral nutrition (tpn); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tp...
HCPCS code
Name of the Procedure:
Home Infusion Therapy for Total Parenteral Nutrition (TPN), more than one liter but no more than two liters per day. HCPCS Code S9366
Summary
Home infusion therapy for total parenteral nutrition (TPN) involves delivering nutrition directly into the bloodstream via a catheter. This service includes all administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, vital for individuals who cannot consume or absorb food through traditional means.
Purpose
This procedure addresses severe nutritional deficiencies often found in patients with digestive system disorders, short bowel syndrome, or post-surgical conditions that impair the ability to ingest food orally. The goal is to provide essential nutrients to maintain patient health, prevent malnutrition, and improve overall quality of life.
Indications
- Severe gastrointestinal disorders
- Chronic intestinal pseudo-obstruction
- Short bowel syndrome
- Severe Crohn’s disease or ulcerative colitis
- Complications from gastrointestinal surgery
Preparation
- Baseline blood tests to assess nutritional deficiencies and organ function
- Fasting may be necessary for a specified period before the initiation of TPN
- Skin preparation for catheter placement, if not already in place
- Review of the patient’s medical history and current medications
Procedure Description
- Catheter Placement: A central venous catheter is usually inserted into a large vein.
- Preparation of TPN Solution: The TPN solution is custom-prepared in a pharmacy, based on the patient's nutritional needs.
- Administration: The TPN solution is infused through the catheter using an infusion pump.
- Monitoring: Regular monitoring of the patient's lab values and overall health is conducted to adjust the TPN formulation as needed.
Duration
The infusion typically takes 12-24 hours per day, and this could be a lifelong treatment or used for a period as determined by the doctor.
Setting
Usually performed at home under the supervision of a home health care team. Initial catheter placement might require a hospital or outpatient clinical setting.
Personnel
- Home health nurse
- Pharmacist
- Nutritionist or dietitian
- Primary care physician or specialist coordinating the overall care
- Patient and family members or caregivers trained in administration techniques
Risks and Complications
- Infection at the catheter site
- Blood clots
- Liver dysfunction over long-term use
- Electrolyte imbalances
- Risk of sepsis
Benefits
- Provides complete nutrition when oral or gastroenteral feeding is not possible
- Can be administered at home, reducing hospital stays
- Improves the patient's overall nutritional status and quality of life
Recovery
- Regular blood tests to monitor nutritional status and organ function
- Maintaining the cleanliness of the catheter site to prevent infections
- Follow-up appointments with healthcare providers for continued adjustments and monitoring
Alternatives
- Gastrostomy or jejunostomy feeding tubes for enteral nutrition, if possible
- Oral nutritional supplements, depending on the patient's condition
- Adjusting the diet to include more nutrient-dense food, which might be feasible for less severe cases
Patient Experience
Patients might feel an initial discomfort during catheter placement but typically adjust over time. The infusion process is generally painless, though the patient needs to adhere to strict schedules and maintenance routines. Pain management and comfort measures include the possible use of analgesics during catheter placement and training on ensuring the equipment’s integrity.