Oncology & Hematology Coding Alert

Version 14.2 of the national Correct Coding Initiative (CCI) now bundles 90769 (Subcutaneous infusion for therapy or prophylaxis [specify substance or drug]; initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site[s]) into observation, inpatient care and hospital discharge E/M codes 99218-99239, as well as most E/M services in the 99251-99440 range.

In other words: You cannot report an initial subcutaneous infusion as described by 90769 separately if it occurs during any E/M service to which CCI now bundles the infusion.

In the facility, the hospital nurse would perform the infusion on physician orders. Thus, the physician would never charge an infusion code in the hospital inpatient, outpatient or observation departments.

For example, if the patient receives infusion during an observation stay as reported by 99219 (Initial observation care, per day, for the evaluation and management of a patient -), you would not report 90769 separately.

Note, however, that the CCI will allow you to override most of these code pair edits (bundles) by appending an appropriate modifier to the infusion code (90769).

When you would unbundle: -Basically, you can use modifier 59 [Distinct procedural service] if the observation or consult or nursing home visit is done at a different time [that is, a separate patient encounter] than the infusion,- says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

-I would recommend that times be put in the chart for the E/M and for the infusion to solidify the claim of separate times,- Cobbuzi says, adding, -separate times does not mean five or 10 minutes apart.-