Gastroenterology Coding Alert

Report first hour of Remicade infusion with G0359 This year, gastroenterology offices must note several new G codes, especially if they perform Photodynamic Therapy (PDT) and administer Remicade infusions.
 
Reason: Medicare released a slew of new Medicare HCPCS Level II G codes for injections and infusions, including new codes for PDT and Remicade.

Look for the new codes in the following three injection/infusion categories, according to a November news release from CMS:
    infusion for hydration;
   nonchemotherapy, nonhydration therapeutic/diagnostic [injections and infusions]; 
  and chemotherapy administration [infusions and injections]. (Note: For a list of all of the G codes Medicare expects you to use in 2005, see Clip N Save: Ease Adjustment Period By Posting These G Codes). Don't wait to put these on your claims, because the G codes were effective on Jan. 1, and CMS removed the grace period.  If you use the old CPT codes for injections/infusions, Medicare will not reimburse in 2005, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.

Take note: Medicare has also changed the rules on reporting everything from a simple therapeutic injection to an eight-hour infusion session, so you should know the new guidelines to avoid payment problems.

Here's how our experts say you should use the new G codes in your office. Use G0345-G0346 for IV Hydration Medicare has mandated comprehensive changes for coding that describes intravenous (IV) procedures focused on hydration. When you report an IV hydration procedure to Medicare in 2005, you should report:  G0345 (Initial infusion, up to one hour) for the first hour of infusion time.
   G0346 (Each additional hour, up to 8 hours) for the subsequent infusion time.
Coding Impact: In 2005, Medicare will not accept the following codes for IV hydration procedures infusions:
   90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for the first hour of infusion time.
   90781 ( ...each additional hour up to eight [8] hours [List separately in addition to code for primary procedure)for the subsequent infusion time. Do it this way:  Consider this coding scenario in which you use the new IV hydration G codes. Information comes courtesy of Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel:
 
Scenario: A Medicare patient with a several-day history of vomiting and diarrhea is seen in the office and found to have very low blood pressure and tachycardia indicative of dehydration.  The physician orders infusion of 1,000 milliliters of normal saline solution given over three hours.
 
When filing with Medicare, you should:
   report G0345 for the first hour of infusion.
   report G0346 x 2 for the next two hours of infusion. Changes Affect Remicade Delivery Reporting Further, Medicare will not accept 90780 [...]