Oncology & Hematology Coding Alert

You know you should use modifier -59 to indicate when the oncologist performs separate, medically necessary services during the same treatment session. But it's not always easy to append the modifier correctly when reporting chemotherapy services.
 
Remember these tips the next time you're unsure whether to attach modifier -59 (Distinct procedural service) to the appropriate chemotherapy code.

Report 96408-59 Once Per Treatment

 1. Medicare allows you to report 96408 (Chemotherapy administration, intravenous; push technique) along with 96410 (... infusion technique, up to one hour) if your oncologist administers chemo drugs to the same patient using different methods. The key is to attach -59 to 96408 - but you can report 96408-59 only once per encounter regardless of how many drugs your physician administers, says Carolyn M. Davis, CMA, CPC, CCP, CCS-P, CPHT, TMC, billing supervisor for Oncology Hematology West in Papillion, Neb., and a professional coding and continuing-education instructor at Iowa Western Community College.

 2. Make sure your oncologist documents that he or she administered the chemo by push technique and used a different drug from the infusion. For instance, your oncologist gives a pancreatic cancer (157.x) patient 200 mg of Gemzar (J9201) using an infusion technique (96410). Later that day, your physician uses the push technique to administer 500 mg of 5-Fluorouracil (5-FU)  (J9190). Your physician should specify how he injected each drug. In this case, you would report J9201, J9190, 96410 and 96408, and link 157.x to each code.

 3. Modifier -59 also comes in handy when you need to unbundle 96410 (... infusion technique, up to one hour) and +96412 (... infusion technique, one to 8 hours, each additional hour [list separately in addition to code for primary procedure]) from 96414 (... infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump). Typically, you'll unbundle these codes when your oncologist begins a prolonged infusion in the office after an actual office chemo administration, Davis says.
 
For example, your oncologist treats a patient with colon cancer (153.x) with two hours of in-office chemotherapy. During the same visit, your physician starts the prolonged infusion (96414) of oxaliplatin (eloxatin) (J9999, Not otherwise classified, antineoplastic drug), which your physician sends home with the patient, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.
 
Your physician's documentation has to show that your physician gave the chemotherapy in-office prior to starting the oxaliplatin infusion. For the first hour of chemotherapy, report 96410 (Chemotherapy administration, intravenous; infusion technique). Do not attach modifier -59 (Distinct procedural service) to 96410. You could also assign 96414 to the prolonged infusion, Lively says.

Double-Check Your Modifier -59 Usage

Before appending modifier -59 to any oncology code, make sure your physician's documentation will support its usage. In addition, you should make sure other modifiers wouldn't be more appropriate.
 
Tip: Although an insurer may pay for your -59 usage, that doesn't mean you've used it correctly. And if the insurer thinks you've acted inappropriately, you could be audited.
 
A good way to ensure you're properly using -59 is to ask yourself the following questions: