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Oncology & Hematology Coding Alert

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Payment Techniques for Heparin,Saline and Supplies

Published on Sat Jun 01, 2002

Medicare and private insurers consider most supply costs associated with chemotherapy administration (96400-96549) to be covered under the procedure's payment. Yet, oncology practices can get paid for supplies such as heparin and saline.

Guidelines for Heparin and Saline Payment

The key phrase associated with heparin (J1642) and saline (J7030-J7050) noncoverage is "at the same time." Although Medicare is clear that it will not pay for contemporaneous administration of saline and heparin, it does pay for the two supplies when given before or after chemotherapy delivery, says Stephanie Thompson, CPC, practice manager for Lexington Oncology Associates, an oncology practice in Kentucky.

When used for hydration therapy to maintain line patency, both saline and heparin are covered. In addition, oncology practices may report a separate code to describe the administration of saline and heparin 90780-90781 (Therapeutic or diagnostic infusions).

However, most Medicare carriers bundle heparin used to flush a port before chemotherapy administration by an implantable pump (96414 ... infusion technique, initiation of prolonged infusion [more than eight hours], requiring the use of a portable or implantable pump). Medicare maintains that administering fluids to ensure vascular access between courses of chemotherapy at the same session is essential for chemotherapy administration and is not separately billable. However, if a practice can show that a port flush is a distinct and separate service from the chemotherapy administration, heparin can also be billed. The same general rule applies when using saline to clean ports. If saline is used prior to the administration of the chemotherapy agent, you may bill for the cost of saline.

Medicare allows separate payment for saline or other intravenous solution used for hydration with or without chemotherapy. However, Medicare includes any saline or intravenous solution used for the chemotherapy drug administration in the infusion reimbursement.

Although flushing a vascular access port before chemotherapy administration is integral to the procedure and not separately payable, if the patient makes a special visit to the physician's office for port flushing, report 99211 (Office or other outpatient visit ...).

Private Payers May Pay for Other Supplies

Because private payers' reimbursement policies vary, applying Medicare rules across-the-board could leave money on the table. Oncology practices may find that commercial payers often reimburse items such as needles and syringes (A4206-A4209).

Among additional items that many non-Medicare insurers may pay for include:

  • Blood tubing, arterial or venous (A4750)
  • Surgical trays (A4550)

    Surgical trays are perhaps the most common item you can negotiate for payment, says Elaine Towle, CMPE, practice administrator for New Hampshire Oncology-Hematology in Hooksett.

    Commercial payers, especially managed care organizations, may provide less reimbursement than Medicare for the same procedures. So, with oncology practices getting less money but incurring the same costs, even small items such as individual supplies used during chemotherapy can take their toll on a practice's bottom line.

    The first step to getting paid for supplies by commercial payers is to include the items in the contract between payer and provider.

    Towle says that commercial payers may acquiesce. For example, many commercial payers will reimburse $30-$40 for surgical trays, which may include needles, slides, tubing, syringes, dressing, gauze and other items. Medicare, on the other hand, clearly says these items are not reimbursable.

    Towle also warns against automatically assigning 99070 (Supplies and materials, provided by the physician over and above those usually included with the office visit or other services rendered). This code was not intended to be a blanket code for all supplies. Instead, it should be used when a practice can show that it was required to use more supplies than normal.

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