Oncology & Hematology Coding Alert

Oncology practices that have been billing for both chemotherapy administration and the use of infusions pumps and have had difficulty getting reimbursed for the latter may be running into trouble for a good reason they may be wrong when they bill and expect to be reimbursed for both.

Using infusion pumps in the office, whether external pumps or internal pumps, is not a billable item, says Elaine Towle, practice administrator for New Hampshire Oncology and Hematology, an oncology practice in Hooksett. The proper way to bill for using infusion pumps during in-office chemotherapy is to use codes 96410-96423 (chemotherapy administration, infusion technique). On the other hand, if a practice sends a patient home with a pump, it cannot use the chemotherapy infusion codes (96410-96423) because there was no office administration of chemotherapy drugs. Instead, Medicare considers the administration of the chemotherapy agent to be self-administered and the provider is entitled to bill only for the cost of the drug itself.

You cant get there from here, Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., in Dallas, Ga, says of billing both chemotherapy administration and the use of infusion pumps.

Billing Opportunities

A common procedure in these situations is for the oncology practice to fill the pump, teach the patient how to use the pump, send the patient home to self-administer the first dose of chemotherapy, refill subsequent doses, and then discontinue its use when the therapy is completed. Despite not being able to bill 96410 through 96423, this procedure does allow for several billing opportunities.

First, Towle says, there are chemotherapy administration codes that apply in these instances. Filling and refilling the pump should be coded separately, using code 96414 (infusion technique, initiation of prolonged infusion [more than eight hours], requiring the use of a portable or implantable pump), 96520 (refilling and maintenance of portable pump) or 96530 (refilling and maintenance of implantable pump or reservoir).

The next billing opportunity is the E/M service associated with the office visit the patient made to receive the pump and learn how to use it. Of course, the requirements of an E/M visit must be met. If the patients physician was not present during this visit, use 99211, the lowest level visit for an established patient, says Towle, because code 99211 does not require a physicians presence. Before correctly billing for a higher level of service, 99212-99215, a physician must be present and the three components history, examination, and medical decision-making must be completed and documented.

Another billing opportunity is the rental of the infusion pump. Some practices may be using E codes incorrectly to bill for rental of the pumps with evaluation and management (E/M) [...]