Name of the Procedure:

Home infusion therapy, corticosteroid infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (HCPCS Code S9490)

Summary

Home infusion therapy for corticosteroids involves administering medication at home through an intravenous (IV) line to manage inflammation and other conditions requiring steroids. This service includes administrative duties, pharmacy services, and care coordination, while drugs and nursing visits are billed separately on a per diem basis.

Purpose

Medical Conditions Addressed:

• Chronic inflammatory diseases (e.g., rheumatoid arthritis, lupus)
• Severe asthma
• Multiple sclerosis exacerbations
• Certain cancers and hematologic conditions

Goals/Expected Outcomes:

• Reduce inflammation and suppress immune responses
• Alleviate symptoms and prevent flare-ups
• Improve patient quality of life by allowing treatment at home

Indications

Symptoms/Conditions Warranting the Procedure:

• Persistent or severe inflammation unresponsive to oral medications
• Conditions requiring long-term corticosteroid therapy without hospital admission

Patient Criteria:

• Stable enough to receive treatment at home
• Access to a caregiver or primary support person
• No history of severe allergic reactions to corticosteroids

Preparation

Pre-Procedure Instructions:

• Review medication list with the healthcare provider for potential interactions
• Blood tests to monitor liver function, kidney function, and electrolytes
• Ensure proper venous access (e.g., PICC line) is in place

Procedure Description

1. Setting Up:

   • Delivery of necessary supplies and equipment by a home infusion provider
   • Initial visit by a nurse to set up the IV line and demonstrate procedures

2. Infusion Preparation:

   • Pharmacy prepares corticosteroid infusion as per prescription
   • Nurse prepares the IV line and ensures correct dose is administered

3. Infusion Process:

   • Medication infused over a prescribed period while monitoring patient vitals
   • Patient remains in a comfortable position and is encouraged to report any discomfort

4. Completion and Monitoring:

   • Nurse disconnects the IV line and ensures no immediate adverse reactions
   • Dispose of or store equipment as instructed

Duration

The infusion can take between 30 minutes to several hours, depending on the specific medication and prescribed dose.

Setting

• Primarily conducted in the patient's home
• May require occasional visits to a healthcare facility for assessments

Personnel

• Registered Nurse (RN) for infusion setup and administration
• Pharmacist for drug preparation and dosing guidance
• Care Coordinator for overall management and scheduling

Risks and Complications

Common Risks:

• Local site reactions (e.g., bruising, irritation at IV site)
• Minor allergic reactions

Rare Risks:

• Severe allergic reactions (anaphylaxis)
• Infection at the IV site
• Blood clots

Management of Complications:

• Immediate discontinuation of infusion and medical attention for severe reactions
• Antibiotics for infections
• Protocols for managing minor to moderate side effects

Benefits

Expected Benefits:

• Effective management of inflammation
• Comfort and convenience of home-based treatment
• Reduced need for hospital admissions

Realization Time:

• Benefits typically noticed within days to weeks, depending on the condition treated

Recovery

Post-Procedure Care:

• Monitoring by a caregiver for any delayed reactions
• Proper hydration and medication adherence

Recovery Time:

• Patients generally resume normal activities within hours
• Regular follow-up for reassessment of condition and treatment efficacy

Alternatives

Other Treatment Options:

• Oral corticosteroids
• Hospital-based IV therapy
• Biologic therapies

Pros and Cons:

• Home therapy offers convenience but requires stable health status
• Hospital therapy provides immediate access to medical care but is less convenient

Patient Experience

During the Procedure:

• Mild discomfort from the IV insertion
• Ability to engage in normal activities such as reading or watching TV

After the Procedure:

• Possible mild fatigue or minor side effects such as nausea
• Instructions for when to seek help for potential complications

Pain Management and Comfort Measures:

• Over-the-counter pain relievers as needed for IV site discomfort
• Comfort measures such as covered warm compresses for IV site irritation