Oncology & Hematology Coding Alert

Claims that report the administration of support-care drugs -- whether the drugs are given by infusion or injection -- should be coded separately from chemotherapy administration when the two procedures are done sequentially of chemotherapy.
 
Some oncology practices may be unnecessarily bundling nonchemotherapy infusions and injections, believing that Medicare considers the services part of same-day chemotherapy administration, says Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.
 
Code 90780 (therapeutic or diagnostic infusion, administered by physician or under direct supervision of physician; up to one hour) is normally used to report the infusion of drugs such as antiemetics that combat nausea caused by chemotherapy, antibiotics, steroidal agents, and hydration, or restore depleted electrolytes. In addition to 90780, 90781 (... each additional hour, up to eight [8] hours) should be listed with 90780 to report non-chemotherapy infusions greater than one hour.
 
Code 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) is used to report injections of supportive drugs, such as epoetin alpha (Q0136) or antiemetics.
 
Cancer patients in chemotherapy treatment often receive a series of injections and infusions as part of the care. A routine chemotherapy visit may include the administration of support-care drugs and chemotherapy. If  the support-care drugs are infused or injected sequentially to chemotherapy, the two procedures performed that day can be paid separately, Hickey says.
  
To prove that the drugs and chemotherapy were provided sequentially, oncology practices should append modifier -59 (distinct procedural service) to each therapeutic infusion or injection code, says Lillie McAlister, CPC, president of Double-Diamond Enterprises, a coding and billing consulting firm in Conroe, Texas. You must ensure that the patient record reflects the sequence of drugs, and it should note the times the drugs were delivered. For example:
 

Hydration therapy, 8 a.m.-10 a.m.

Cisplatin, 12:30 p.m.-1:30 p.m.

Granisetron, 2 p.m.

 
When billing 90780 or 90781, providers are required to give the name of the drug or solution. Medicare also requires the physician to be present during the infusion. Codes 90780 and 90781 should be used for prolonged infusions. They are not used for intradermal, subcutaneous, intramuscular or IV push drug injections, which are reported with 90782-90799.
 
In the example above, the patient record supports the sequential delivery of chemotherapy and support-care drugs. This allows the oncology practice to list 96410 (... infusion technique, up to one hour) for the one-hour infusion of cisplatin (J9060), 90780 for the first hour of hydration therapy, 90781 for the second hour, and 90782 for the injection of granisetron, an antiemetic.
 
In addition to the injection or infusion codes, bill for the cost of all drugs used by listing the appropriate J code for the support and chemotherapy drug. You must be careful, however, when coding for hydration therapy. For example, if a patient is given hydration with a 0.9 percent sodium chloride solution prior to the administration of cisplatin, the saline used to hydrate the patient prior to administration of the chemotherapy drug can be submitted to Medicare for reimbursement. If the same patient was given a 50-ml bag of intravenous solution that is used to mix the drug, the solution is considered included in the reimbursement for the chemotherapy IV infusion.

 
When reporting 90780 or 90782, include the following items on the claim form:
 

The name and dosage of the agent infused, if the specific code is not billed on the claim.
 

The specific agent used when billing a "not otherwise classified" HCPCS code (J3490, J9999); the agent and the dosage administered must be indicated in the documentation record for claims submitted electronically or in Item 19 of the HCFA 1500 claim form.
 

A diagnosis code supporting the medical necessity of the service/procedure must be submitted in the appropriate ICD-9 field. In the case of oncology patients, the appropriate cancer diagnosis code should be the primary diagnosis.
 

Claims submitted with 90781 must include the reason the infusion is prolonged beyond one hour.

 
When reporting 90780 or 90782, also use the appropriate E/M code. Medicare regulations allow for separate payment of chemotherapy administration and same-day E/M visits.
 
Some coders may neglect to bill separately for an E/M visit with 90782 because Medicare regulations do not allow payment for the administration of an injection when the injection is given on the same day as an office visit or other service. Injections for chemotherapy are the only exception.