Oncology & Hematology Coding Alert

When a chemotherapy regimen is prescribed, it may require that multiple agents be given during the same visit. It is also common for the chemotherapy drugs to be given using different techniques. Coders in oncology practices must remember that the administration of multiple chemotherapy agents is separately payable by Medicare when the drugs are delivered using different routes, says Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett, N.H.

For example, a patient with breast cancer (174.0-174.9) may receive one agent via intravenous push and others via intravenous infusion. Commonly, this is done using cyclophosphamide (J9070-J9097), doxorubicin (J9000), and 5-FU, (J9190). Some physicians administer both cyclophos-phamide and doxorubicin by IV infusion (e.g., 96410, Infusion technique, up to one hour, +96412, ... one to 8 hours, each additional hour [list separately in addition to code for primary procedure]), while the 5-FU is administered by IV push (e.g., 96408, Chemotherapy administration, intravenous push technique). When to Use Modifier -59 The CPT 2002 manual states that separate codes should be reported for each parenteral method of administration when chemotherapy is administered by different techniques. Therefore, you should bill both codes when both techniques are used. Apply modifier -59 (Distinct procedural service) to the lesser-paying chemotherapy administration code (96408) to ensure identification of these as separate procedures. So the example given above should be coded 96410 (include +96412 if applicable) for the administration of cyclophosphamide and doxorubicin and 96408 for the administration of 5-FU; modifier -59 appended to 96408 shows payers that the IV push was a separate and distinct service from the infusion administration. Finally, code each of the chemotherapy drugs administered. Medicare will pay for both a push and an infusion on the same day if different drugs are involved, but it will pay for only one administration by push technique (96408) per encounter regardless of how many drugs are administered. J codes for each drug should always be reported and linked to the corresponding technique code on the claim form. While Medicare does not allow the push technique to be reported twice, some commercial payers may pay for it, Towle says. Check with commercial payers to ensure they are not applying Medicare coding practices. Reporting Support Drugs In addition to chemotherapy agents, drugs that combat chemotherapy symptoms, such as anemia and nausea, will be a part of the coding mix. If it is simultaneous to chemotherapy, the administration of support drugs is bundled with chemotherapy administration codes.

Sequential administration of support-care drugs and chemotherapy, on the other hand, allows for billing the two procedures separately, says Lillie McAlister, CPC, president of Double Diamond Enterprises, a coding and consulting firm in Conroe, Texas. Some oncology practices, however, mistakenly [...]