Oncology & Hematology Coding Alert

An article titled "Payment Techniques for Heparin, Saline and Supplies" in the June edition of Oncology Coding Alert requires clarification.

In article 4, the article states: "When used for hydration therapy to maintain line patency, both saline and heparin are covered. In addition, oncology practices may report a separate code to describe the administration of saline and heparin 90780-90781 (Therapeutic or diagnostic infusions)."

This statement seemed ambiguous to many readers. The HCPCS codes J1642 (Injection, heparin sodium, [Heparin Lock Flush]) and J7030-J7050 (Infusion, saline solution) may be reimbursed by some private insurance carriers; they may also be reimbursed by some Medicare payers. However, the procedure codes (90780-90781) will not be reimbursed for the use of saline or heparin for line patency because this use is considered routine for administering chemotherapy and therefore is included in the chemotherapy CPT code (96408-96414).

90780-90781, along with the J codes for saline or other drugs, will be reimbursed only if they are given to provide hydration not as an infusion to keep the line or vein open during administration, or as a piggyback in concert with the chemotherapy.

How can a coder tell if the saline is used for hydration or for line patency? The first hint is to look at the volume of fluid. Saline hydration is typically given in volumes of 500cc or more, whereas saline flushes or bags used for patency are 250cc or less. And, hydration is usually started either an hour prior to the chemotherapy or after the procedure is completed. (Clarification provided by Margaret M. Hickey, MS, MSN, RN, OCN, CORLN.)