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Home infusion therapy, total parenteral nutrition (tpn); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard...

HCPCS code

Name of the Procedure:

Common Name: Home Infusion Therapy for TPN
Technical or Medical Term: Home Infusion Therapy, Total Parenteral Nutrition (TPN) of more than two liters but no more than three liters per day (HCPCS Code: S9367)

Summary

This procedure involves providing Total Parenteral Nutrition (TPN) through home infusion therapy. It includes the administration of more than two liters but no more than three liters of nutrient-rich solution per day, along with necessary administrative services, professional pharmacy services, care coordination, and all required supplies and equipment.

Purpose

Medical Conditions Addressed: Severe gastrointestinal disorders, chronic conditions that impair nutrient absorption, and other medical conditions that prevent adequate oral nutrient intake. Goals/Expected Outcomes: To ensure the patient receives essential nutrients, vitamins, and minerals directly into their bloodstream, improving nutritional status and overall health.

Indications

Symptoms/Conditions Warranting the Procedure:

  • Severe gastrointestinal malabsorption
  • Short bowel syndrome
  • Crohn's disease
  • Chronic intestinal pseudo-obstruction Patient Criteria:
  • Inability to meet nutritional needs through oral or enteral feeding
  • Medically stable for home care infusion

Preparation

Pre-Procedure Instructions:

  • No specific fasting required
  • Medication review by healthcare provider Diagnostic Tests Required:
  • Blood tests to assess nutritional deficiencies
  • Imaging studies to evaluate gastrointestinal tract if necessary

Procedure Description

Steps Involved:

  1. Initial assessment by a healthcare provider.
  2. Placement of a central venous catheter if not already in place.
  3. Preparation and delivery of TPN solution by a professional pharmacy service.
  4. Coordination of care and supplies by the healthcare team.
  5. Patient or caregiver training on how to administer TPN at home, maintain catheter care, and recognize signs of complications. Tools/Equipment Used:
    • Central venous catheter
    • Infusion pump and related supplies
    • Custom-prepared TPN solutions Anesthesia/Sedation:
    • Local anesthesia may be used for catheter placement.

Duration

Typical Duration:

  • Infusion usually takes several hours daily, depending on the volume prescribed (more than two to three liters).

Setting

Where Performed:

  • Patient's home environment, under the supervision of healthcare professionals.

Personnel

Healthcare Professionals Involved:

  • Pharmacists
  • Nurses
  • Dietitians
  • Physicians specializing in nutrition or gastroenterology

Risks and Complications

Common Risks:

  • Infection at the catheter site
  • Blood clots in the central venous catheter Rare Complications:
  • Metabolic imbalances (electrolyte disturbances, liver dysfunction)
  • Catheter-related injuries Management of Complications:
  • Immediate medical evaluation and treatment

Benefits

Expected Benefits:

  • Improved nutritional status
  • Enhanced energy levels
  • Prevention of further malnutrition Realization Timeframe:
  • Benefits can be seen within days to weeks.

Recovery

Post-Procedure Care:

  • Regular monitoring of blood tests and nutritional status
  • Ongoing catheter care and TPN administration Expected Recovery Time:
  • Varies based on individual health needs; typically requires long-term management Restrictions and Follow-Up:
  • Regular follow-up appointments with healthcare providers

Alternatives

Other Treatment Options:

  • Oral or enteral feeding when feasible
  • Alternative specialized diets Pros and Cons of Alternatives:
  • Oral/enteral feeding is less invasive but may not be possible for all patients.
  • Specialized diets can be less complex but may not meet complete nutritional needs for some individuals.

Patient Experience

During the Procedure:

  • A sensation of coolness or mild discomfort from the infusion.
  • Patient education is critical to ensure proper administration. After the Procedure:
  • Regular monitoring for signs of complications.
  • Pain management as needed for catheter-related discomfort.
  • Support from a healthcare team to ensure patient comfort and address any concerns.

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