Oncology & Hematology Coding Alert

Boost your efficiency using infusion documentation sheets.

Accurate infusion coding starts by mastering the fundamentals.

"You must have documentation of the exact drug, amount given, route of administration, and start/stop times at minimum to code properly," says Shelly Noll, CPC, who works in oncology, hematology, and radiation for Rockwood Clinic in Spokane, Wash.

Read on to see why these four areas are so important to your coding accuracy.

1. Simplify Matching Drug Names to Documentation

Each drug a patient receives may have multiple names, including a generic name and various brand names. Your documentation may include any of these, so you've got to be on the ball to match the drug name to the proper HCPCS code.

Try this: An infusion documentation sheet that shows both brand names and generic or chemical names for the drugs you infuse can be very helpful, says Melanie D. Kramer, CPC, certified clinic coder for Bozeman Deaconess Health Group in Bozeman, Mont.

Setting up the sheets by chemotherapy regimen or cancer diagnosis can add to their efficiency of use, Kramer says. And you want to be sure that you include not only chemotherapy drug names, but your "premeds," as well, says Kramer.

Example: Some of the drugs you may see include the following:

An automated medication dispensing system printout from the pharmacy that lists generic/chemical names is another good tool to be sure you're matching the proper code to the proper drug, Kramer says.

And if you can't find a code for a drug, you can try looking up the name in an Internet search engine. You may find an alternative name that you can match to a code, says Noll. Be sure to choose authoritative websites. For example, you can search FDA approved drugs at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.

Bottom line: Coders need to have knowledge of the different drugs and their various names, Kramer says. "When I see Avastin, I know that it is the same as bevacizumab. If I am unsure, I look up the drugs," she says.

2. Pull Out the Calculator for Accurate Units

Accurate drug coding doesn't end with determining which drug matches which code. You also have to report the appropriate number of units based on the code descriptors, the amounts administered, and your payer's rules regarding rounding.

For example: Medicare instructs you to round up your units when the amount administered isn't an exact multiple of the amount in the code definition (Medicare Claims Processing Manual, chapter 17, section 70, http://www.cms.hhs.gov/Manuals).

In other words, if the code descriptor indicates one unit equals 50 mg, and the patient receives 80 mg, then you should report two units.

3. Don't Skimp on Route Documentation

"The documentation of the route of administration" is imperative to choosing the correct CPT codes for the drug administration, says Noll.

CPT's chemotherapy administration codes vary based on administration route. For example, looking just at the "Injection and Intravenous" section, you will see:

The "Therapeutic, Prophylactic, and Diagnostic Injections and Infusions" section is similarly divided based on administration route:

So without documentation of the administration route, you will be unable to pinpoint the proper code.

4. Understand How Time Affects Codings

Many of the chemotherapy administration codes also specify that they cover a specific time range. As a result, if your practice routinely rounds administration times you're at risk of inaccurate coding.

For example: Suppose a patient receives a 94 minute chemotherapy infusion, but the nurse rounds the time and documents a 90 minute infusion. Because CPT instructs you to report "additional hour" codes, such as +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]), "for infusion intervals of greater than 30 minutes beyond 1-hour increments," you would not be able to report +96415 in addition to 96413 (... up to 1 hour, single or initial substance/drug) for the 90 minutes in the record. The 90 minutes recorded equal 60 minutes (96413) plus 30 minutes, and the CPT guideline indicates that an additional 30 minutes of infusion time is not sufficient to merit +96415. Documentation must show at least 31 additional minutes beyond an hour for you to report the "additional hour" code.

Of course, your practice should not make a point of infusing patients for 91 minutes just so you can report the additional code. The patient's actual infusion time should be based on the patient's individual circumstances and what is medically necessary for that patient.