Oncology & Hematology Coding Alert

Bonus: Say goodbye to denial-generating G0354/drug admin bundles

Take down that sticky note reminding you to add modifier 59 to your G0354/drug administration claims - the latest National Correct Coding Initiative edits delivered on the promise to remove edits bundling IV push code G0354 into five other G codes.
 
This quarter, you'll have to take the good with the bad, however. NCCI version 11.2, effective July 1, 2005, also added more than 9,000 edits for injection and IV push G codes.

Double-Check Your G Code Claims

Expect denials if you report drug administration G codes with a whole slew of other procedures.
 
NCCI designated initial intravenous infusion codes G0345 (Intravenous infusion, hydration; initial, up to one hour) and G0347 (Intravenous infusion, for therapeutic/diagnostic [specify substance or drug]; initial, up to one hour) components of 75 codes.
 
The comprehensive codes include catheter insertion codes 51701-51703, brachytherapy codes 77761-77789, new PET tumor imaging codes 78811-78816, and chemo administration codes 96405, 96406 and 96425-96450.
 
Lesson: Don't be tempted to report therapeutic infusion code G0347 alongside a chemotherapy administration code, such as 96445 (Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis). Payers that adopt the NCCI edits will only pay for the chemotherapy administration - the more extensive comprehensive code - if you do.
 
Reason: Payers consider injection to be an inherent part of most procedures, says Dawn Hopkins, senior manager for reimbursement with the Society for Interventional Radiology. Either CMS is seeing "widespread abuse" of the new injection G codes by physicians trying to bill for them with many procedures, or this is a precaution.
 
CMS may simply be trying to block all of the code combinations that haven't been commonly used so far, because they assume nobody ever bills them together, Hopkins says. NCCI gave these edits a modifier indicator of "1," so if the situation warrants it, you may be able to use a modifier to override those edits.

Push Away Hope for G0351-G0354 Payment

According to NCCI, injection code G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) is a component of 4,531 codes, and intravenous push codes G0353-G0354 are components of 4,833 codes. What this means for you:  NCCI bundles G0351, G0353 and G0354 into brachytherapy codes 77761-77789, new PET tumor imaging codes 78811-78816, and chemo administration codes 96405, 96406 and 96425-96450, so don't expect payment for the G codes along with the CPT procedure codes. Caveat: Each of these has a modifier indicator of "1," meaning that if your documentation supports it, you may override these edits.
 
Snag: Private payers may have their own ideas. Even those that claim to follow CMS rules may have different requirements when it comes to processing G code claims, says Sarah Nachimson, CPC, with the Palm Beach Cancer Institute in Florida. Best bet: Keep track of each payer's preferences.
 
Don't miss: Code G0363 (Irrigation of implanted venous access device for drug delivery systems [do not report G0363 if an injection or infusion is provided on the same day]) is now a component of 87 evaluation and management and workers' compensation codes, from 99201 to 99456. You won't be able to use a modifier to override those edits, because NCCI gave these a modifier indicator of "0." Translation: Many payers already considered flushing a vascular access port prior to chemo integral to the chemotherapy administration, meaning you couldn't separately report the flush unless the patient made a special visit to the office just for the port flushing. Now, you also can't report the flushing separately if you report these E/M or workers' compensation codes.
 
Experts warn: Some manufacturers and vendors insist that you may report G codes in addition to the procedural codes for their products, but your payer may not agree, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the AAPC National Advisory Board.  
 
Remember: Your vendor isn't the authority when it comes to deciding which codes are appropriate. Follow payer guidelines.

Delight in the G0354 Deletion

NCCI deleted edits bundling G0354 (Each additional sequential intravenous push [list separately in addition to code for primary procedure]) with five other drug administration codes: G0345, G0347, G0357, G0359 and G0361.
 
These edits contradicted the principle that you should be able to report an administration code for each drug you give. CMS relented, instructing coders to apply modifier 59 (Distinct procedural service) until NCCI 11.2 made the deletion official.