Oncology & Hematology Coding Alert

With the host of drugs that accompany chemotherapy, it is often expedient to lump such drugs as Ondansetron, a nausea combatant, in with chemotherapy administration even if the treatments were administered over two distinct time periods.

But dont waste billing opportunities by automatically bundling supportive care drugs with chemotherapy administration, says Laurie Lamar, RRA, CCS, CTR, CCS-P, reimbursement specialist with the American Society of Clinical Oncology in Alexandria, Va.

With proper documentation of chemotherapy and the use of supportive drugs, she says that practices can bill them as two distinct services. When billing for hydration therapy IV (90780 and/or 90781) and chemotherapy IV infusion (96410, 96412, or 96414) performed on the same day, sequentially, or as a separate procedure, you must place modifier -59 (distinct procedural service) on the hydration therapy IV codes.

For example, an oncology practice treating a breast cancer patient who receives an intravenous dose of Ondansetron (J2405), an anti-emetic therapy, just prior to receiving an infusion of chemotherapy (96410, infusion technique, up to one hour) can separate supportive care drugs and chemotherapy administration for billing purposes.

Rules for Medicare call support care drugs to be billed separately if they are administered sequentially to chemotherapy treatment, she says. For coverage of these drugs, payers require that the drug be indicated for use with chemotherapy agents. In the case of anti-nausea medication, the chemotherapy drug must be listed as an agent that causes adverse reactions of moderate-to-severe vomiting.

On the other hand, if the administration of both the anti-emetic drug and chemotherapy is done simultaneously, the practice has no choice but to bundle the administration of the anti-nausea drug with chemotherapy administration, Lamar says.

Note: In addition to using the CPT codes 96400-96549 for chemotherapy administration, oncology practices can also bill 90780 (IV infusion therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour).

Careful Documentation Is Key

Oncology practices need to take care in documenting the sequence of drug administration, says Daniel Johnson, director with Health Care Consultants of America, an Augusta, Ga.-based coding consulting firm with oncology practice clients. [Supportive care] drugs should be coded separately whenever possible, he says.

To prove that the support care drugs and chemotherapy were provided sequentially, Lamar says the record should note the times the drugs were delivered.

For example:
Ondansetron 11 a.m. - 11:45 a.m
Chemotherapy 12:30 p.m. - 1:30 p.m.
Ondansetron 2 p.m. - 2:30 p.m.

But Lamar cautions coders to be on guard against vague notations in the documentation, such as: Ondansetron, Chemotherapy from 11 a.m. to 2:30 p.m.

This scenario would be coded:

Simultaneous Sequential
Administration Administration
96410 96410
J9060 90780-59
J2405 90781
J9060
J2405

Some insurance carriers may require [...]