Oncology & Hematology Coding Alert

If you think coding chemo is a snap, you might be in for a surprise

The next time your oncologist treats a chemotherapy patient, you can report the chemotherapy and therapeutic procedures with confidence if you know how to code some common oncology scenarios.

1. Using the push technique, the oncologist administers three doses of the same anti-neoplastic drug to a patient on the same day.

You should report 96408 x 1 (Chemotherapy administration, intravenous; push technique), because the physician provided three doses of the same drug, says Kelly Reibman, CPC, a billing representative for an oncology practice in Easton, Pa. On the other hand, if the physician had given three doses of three different drugs, you could have assigned 96408 x 3, linking the appropriate drug code with the administration code.

2. Your nurse initiates a prolonged pump infusion in the office. The patient will complete the chemotherapy cycle at home.

The nurse began the administration in the office, so you may assign 96414 (... infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump) for the pump initiation, says Sue Coffee, office administrator at Central Illinois Hematology Oncology Center in Springfield, Ill.

Bonus: In many cases, the nurse also provides chemotherapy prior to the initiation. For example, the nurse delivers an hour-long chemo infusion in the office, which you code as 96410 (... infusion technique, up to one hour). If following this infusion the nurse starts the prolonged pump treatment, you should assign 96414-59 (... prolonged infusion ...; distinct procedural service), Coffee says. You need modifier -59 because the National Correct Coding Initiative (NCCI) bundles 96410 and 96414.

3. A patient receives an hour and a half of antiemetics by intravenous infusion in the office.
 
For the first hour, you should report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour), Reibman says. You would use a therapeutic infusion code instead of a chemo code because the physician or nurse gave antiemetics. These drugs treat nausea or vomiting, and do not help fight cancer. To code the other 30 minutes of infusion, you should assign +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]).

4. The patient presents for a chemotherapy pump refill.

Because the nurse simply refills the pump, and the patient will receive the actual administration at home, you should list 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]). This code represents refills and maintenance to a pump or reservoir.

When you assign 96530, make sure you have the following medical documentation: