News You Can Use: Nix Q0081 and Q0083 in Favor of New Chemo Codes
Check out CMS' spate of new OPPS chemo codes
Heads up, hospitals: If you bill drug administration services on or after Jan. 1, 2005, using Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit), Medicare will deny your claim.
The same is true for Q0083 (Chemotherapy administration by other than infusion technique only [e.g., subcutaneous, intramuscular, push], per visit) and Q0084 (Chemotherapy administration by infusion technique only, per visit), because CMS will begin using established CPT chemotherapy and drug administration codes for these services under the hospital outpatient prospective payment system (OPPS), according to a May 20 transmittal.
What to expect: Codes 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia) and 96405 (Chemotherapy administration, intralesional; up to and including 7 lesions) are among eight other codes that you should now use instead of Q0083. For therapeutic and other non-chemotherapy infusions, be sure you report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) in place of Q0081.
CMS also instructs you to use modifier -59 (Distinct procedural service) in unusual cases when a patient makes two separate visits to the hospital for drug administration during the same day. Don't use modifier -59 when the patient receives infusion therapy at more than one site or when the physician stops the infusion and then starts it again in the same encounter.
For CMS' complete OPPS drug administration coding in-structions, go to
www.cms.hhs.gov/manuals/pm_trans/R566CP.pdf.
Use unlisted smoking cessation code for pre-July 5 services
Medicare will now pay for smoking and tobacco-use cessation counseling for services performed on or after March 22, 2005.
Medicare won't pay you for more than eight smoking and tobacco-use cessation counseling sessions in a 12-month period, according to a CMS May 20 transmittal. Counseling sessions lasting less than three minutes are not separately billable and are included in your evaluation and management visit coverage, however.
Make sure you submit your counseling claims with a diagnosis code that reflects the condition tobacco use caused in the patient. Or, if you're treating a patient with a therapeutic agent that's sensitive to the patient's tobacco use - the tobacco affects metabolism or dosage - report the condition that requires this agent.
Use the following codes to bill Medicare Part A and Part B for smoking and tobacco-use cessation counseling, but not until Medicare contractors' systems are updated on July 5:
G0375 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
G0376 - ... greater than 10 minutes.
Important: Use unlisted-procedure code 99199 to bill for smoking and tobacco-use cessation counseling for services between March 22 and July 4. To read the transmittal, [...]
- Published on 2005-06-20
