Oncology & Hematology Coding Alert

1 injection code is the norm on therapeutic shots So you've decided that the service represents an injection, not an infusion. But before deciding on which injection code to use, make sure the nurse has injected a chemotherapy drug into the patient (not a therapeutic drug.)

Chemotherapy drugs are defined as agents that, when administered to the patient, strictly target the cancer cell (antineoplastic).

Code 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia) is designed for chemotherapy drugs only. Reporting an injection of a nonchemo drug with 96400 will not make you popular with payers, and may result in denials.

Note: It also helps to have an ICD-9 code to represent the cancer type when reporting 96400, because many insurers will not pay for chemo drugs without a cancer diagnosis.

Check HCPCS: If you're wondering whether a solution was a chemotherapy drug or a therapeutic substance, let the HCPCS book be your guide. Chemo drug codes are all listed in a single section of the HCPCS guide, under the title "Chemotherapy Drugs: J9000-J9999."

While you're checking J codes, call your insurance carriers, because individual payer policy may also affect the classification of a drug.

Two Injection Codes Are Usually Not Reportable Coders should choose from the following codes for injections of nonchemotherapy drugs, depending on delivery method:

90782 - Therapeutic, prophylactic, or diagnostic injection (specify material injected); subcutaneous or intramuscular, and the appropriate supply code

90783 -  ... intra-arterial, and the appropriate supply code

90784 -  ... intravenous, and the appropriate supply code. When the nurse or doctor performs a therapeutic injection in the same session as a chemo administration, the payer typically bundles the injection into the chemo administration.

Exception: If the oncologist performs a therapeutic injection separately from or sequentially to the chemotherapy administration, the injection may be separately reportable. Check with your provider before filing, though. Even the carriers that accept therapeutic shot codes separately have strict guidelines for the claims.

Translation: Do not just slap modifier -59 (Distinct procedural service) on the injection code and send the claim off. Many insurers may not want to see modifier -59 on claims containing both therapeutic and chemotherapy injection codes.

"It is best to check with each carrier to verify what each carrier would like on the claims," says Kelly Reibman, CPC, billing manager for Mariette Austin, PhD, MD, in Easton, Pa.