Oncology & Hematology Coding Alert

Learn to Bill J Codes Properly With Chemo Infusion 
 
As an oncology coder who deals with chemotherapy administration codes, you sometimes come to a fork in the road: Should you include codes for heparin and saline with your claim or consider them bundled? But if you follow this expert advice, you'll take the right direction.
 
If you want to report your physician's use of heparin (J1642, Injection, heparin sodium [Heparin Lock Flush]) and saline (J7030-J7050, Infusion, saline solution), make sure your oncologist administered them separately from the chemotherapy administration (96400, Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia), says Jan Beach, LHRM, CMM, CPC, consultant and practice administrator in Vero Beach, Fla.
 
Medicare will not reimburse your practice if your physician administers heparin and saline to keep the line or vein open during the chemotherapy, she says.

Note the Start and Stop Times for J7030

Here's a situation in which you could report saline code J7030: An hour before your oncologist treats a colon cancer (153.x) patient with chemotherapy, your physician uses 1,000 cc of saline for hydration therapy.
 
Remember to note the start and stop times, and how long before or after chemotherapy your physician flushed the line and infused saline. Also, make sure to include the volume amount used. If you report code J7030, Medicare requires documentation to substantiate the hydration therapy sequentially administered the same day as (before or after) chemotherapy. Saline volume should total at least 500 cc - CMS links a lower volume with maintaining line patency, placing smaller uninfused amounts in a supply category, which it doesn't cover, Beach says.
 
You cannot report and expect to be paid for codes 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and +90781 (... each additional hour, up to eight (8) hours [list separately in addition to code for primary procedure]) for the saline and heparin treatment. Medicare considers these services routine for chemotherapy administration and includes them in the chemotherapy infusion codes (96408-96414), Beach says.             
 
Before you report saline and heparin codes, you should be aware that carriers will not always reimburse your practice when you report the codes the same day as chemotherapy administration, Beach says. For example, Medicare considers flushing a vascular access port with heparin prior to chemotherapy as integral to the administration. Therefore, CMS would bundle J1642 into 96410 (... infusion technique, up to one hour]).
 
But you may report 99211 (Office visit ...) for the port flushing if the patient came to the office for that particular service, Beach says. Make sure not to report 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]) to Medicare for a port flushing. CMS also considers this a bundled code for flushing, she adds.