Oncology & Hematology Coding Alert

Careful: Your coding may not need to change

If you-ve been reporting non-chemotherapy injections and infusions with moderate sedation services, it's time to clean up your act. The latest National Correct Coding Initiative (NCCI) edits won't let you claim these services together anymore.

Good news: These edits won't require you to make any big adjustments in the way you now code, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

The edits merely correct inappropriate coding.

The lowdown: NCCI version 12.1, released April 1, 2006, bundles hydration and non-chemotherapy injection, infusion, and push codes 90760, 90765, and 90772-90775 into moderate sedation codes 99143, 99144, 99148, and 99149.

Example: You report 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) and 99143 (Moderate sedation services [other than those services described by codes 00100-01999], provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; under 5 years of age, first 30 minutes intra-service time) on the same claim. If your payer adopts NCCI edits, it will only reimburse you for the moderate sedation. But remember, many payers won't reimburse you for moderate sedation, either.

Note: All of the 99143-99144 (... provided by the same physician ...) edits have a modifier indicator of -1,- which means you may unbundle the edit with an appropriate modifier if your documentation reveals the provider performed the services separately. The 99148-99149 (... provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service) edits have a modifier indicator of -0,- letting you know that you should not unbundle these edits under any circumstances.

Feel the Hyperthermia Bundle Heat

If your practice performs hyperthermia, you need to keep an eye out for moderate sedation coding, as well. Codes 99143-99144 are now bundled into 77600-77615 (Hyperthermia ...). These edits have a modifier indicator of -0,- which means you may not undo the bundling under any circumstances. Bottom line: Consider sedation to be integral to placing the hyperthermia applicators and don't charge separately for it.

You can download the full list of edits at www.cms.hhs.gov/NationalCorrectCodInitEd/.