Oncology & Hematology Coding Alert
Edits Affect IV Push and Chemo Administration Codes
Take notice of these bundles and watch -59 shed new light on your G0354 reporting The latest National Correct Coding Initiative edits, version 11.1, are only a ripple in the oncology pool, but you should take note of these few nonmutually exclusive bundles that apply directly to your chemo procedures. Column 2 includes code G0354 (Each additional sequential intravenous push [list separately in addition to code for primary procedure]).
The new edits include codes in column 2 that carriers bundle into the codes in column 1. These are nonmutually exclusive codes with a "1" in the modifier column. Under mutually exclusive bundles, carriers will pay the less expensive procedure.
Exception: An indicator of "1" means that you may use a modifier to override the edit if the procedures are distinct from one another.
The bundles include the following codes in Column 1:
This means that if any of the procedures in column 1 occur at a different location than the additional sequential IV push in column 2, you may report the services independently with modifier -59, coding experts say.
Warning: You must append modifier -59 (Distinct procedural service) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable when supported by documentation, coding experts say. Without modifier -59, the payer will simply apply the NCCI edits and deny payment.
Example: If the oncologist gives a Medicare patient an intravenous dose of ondansetron to fight the patient's nausea after a chemotherapy infusion session that lasts 58 minutes, you should report G0359 and G0354-59, says Lisa Center, CPC, an independent coder in Joplin, Mo.
Modifier -59 notifies the payer that the oncologist administered the ondansetron after the chemotherapy session, so the oncologist did not administer the ondansetron concurrently with the chemotherapy. Instead, the ondansetron administration was a distinct and separate procedure, Center says.
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