Oncology & Hematology Coding Alert

Sneak a peek at the new and revised chemo codes you've been asking for

Avoid the New Year's rush by analyzing the 2006 infusion and injection codes and their guidelines today so you can apply them with ease beginning Jan. 1.

The basics: The American Medical Association released the section of the 2006 CPT update including the codes for drug administration. The new codes are similar to the G codes you-ve been using for drug administration this year, but some concepts are spelled out in more detail. Clarify Concurrent Concept The new codes pay more attention to initial, subsequent and concurrent than the G codes, says Kristi Downey, practice manager with Grand Rapids, Mich., physician Gary Downey.

Concurrent: AMA answered the call for a concurrent infusion code with 90768 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; concurrent infusion).

Initial and subsequent: The 2006 guidelines spell out that you should code only one initial service per encounter, unless you have two different IV sites.

If you provide a patient with an hour of infusion followed by an IV push, you should bill for the IV push using a subsequent IV push code--even though it's the first push you-re providing, the AMA says. Example: You may report 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) with 90775 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug).

The initial code doesn't necessarily reflect the first drug you administer, Downey says. The initial code is the primary reason for the encounter--so for a chemotherapy service, the main chemotherapeutic administration will be your initial infusion code.

Helpful: The AMA clarifies that an IV push is less than 15 minutes and requires a healthcare professional to be continuously present, says Cindy Parman, CPC,
CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the AAPC National Advisory Board.

Separate -Non- and -Antineoplastic- Administration Another important update gives you more detailed instructions for reporting hormonal agents. To report anti-neoplastic hormonal injection therapy, use 94602 (Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic).

For non-antineoplastic hormonal therapy injections, report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug] -).

A note in the Diagnostic/Therapeutic section states: -Do not report 90772 for injections given without direct physician supervision,- Parman says. Instead, use 99211. Wash Away Denials With 90760-90761 You will also have hydration codes (90760-90761) that correspond to this year's G codes. Example: Instead of reporting G0345 (Intravenous infusion, hydration; initial, up to one hour), you-ll report 90760, which will have the same descriptor.

You won't separately report fluid used to administer drugs. The CPT guidelines classify this as -incidental hydration,- Parman [...]