Oncology & Hematology Coding Alert

2. Bill 99211 for Flushes

If you're assigning 96530 for the oncologist's port flushings or blood draws, you could be losing out on reimbursement and violate Medicare requirements for port flushes, Parman says.

When the patient makes a special visit to the oncologist for a port flushing, you should report 99211 (Office or other outpatient visit for the E/M of an established patient ...), according to the Medicare Carriers Manual (MCM), section 15400 (E). Most physicians don't perform routine port maintenance. Instead, they supervise the service.

Don't miss: And, if your oncologist provides vascular access port flushing prior to a chemotherapy treatment, Medicare will consider the flushing to be an integral part of the chemotherapy administration, Parman says. For example, you could not report a separate procedure code (e.g., 99211) along with 96408, (Chemotherapy administration, intravenous; push technique) if the physician flushed the ports before administering chemo.

Watch Out for Blood Draws

If you list 96530 for blood-draw services, you are coding inappropriately, Parman says.

Code 96530 represents the refilling or maintenance of a pump or reservoir. Therefore, using the code to report a blood draw would violate CPT requirements, which state, "Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code."

Typically, you should use the appropriate venipuncture code (36400-36425) to report a blood draw.

3. You Can't Bill 90780 With Chemo Codes

To recoup the $100 reimbursement increase for 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour), you have to know how to report hydration therapy infusion, coding experts say.

Tip: When the oncologist infuses saline, an antiemetic or any other nonchemotherapy drug at the same time as chemotherapy infusion (96410, 96412 and 96414), you cannot report 90780 or +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]). Medicare considers the payment for 90780-90781 included in the chemotherapy reimbursement, according to the MCM, says Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent oncology coding consultant based in New Orleans.

But the government will pay separately for intravenous infusion if the physician provides hydration therapy separate from the chemotherapy services either before or after the chemotherapy administration, Hickey says.

Make sure, however, that you attach modifier -GB (Claim being resubmitted for payment because it is no longer covered under a global payment demonstration), the MCM states. The modifier will indicate that the physician provided the infusion separate from the chemotherapy.

The physician should note in the patient's record the time the physician hung the hydration or antiemetic. And, the physician should document when he or she discontinued the hydration, as well as the start and stops times of the chemotherapy, Hickey says.