Oncology & Hematology Coding Alert

Call on modifier KD to recoup drug costs When coding for prolonged drug infusion via a portable or disposable pump, you must be sure to report all components of the service, from infusion initiation to supplies to ongoing pump maintenance. In addition, you-ll want to be sure that the available documentation meets the precise criteria payers require to support these services.
 
Begin With 96416 When the provider initiates prolonged infusion with a portable or disposable pump in the office, you will first report 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump). -Code 96416 describes the nursing chemotherapy administration service for initiation of the portable infusion pump,- confirms Joyce Matola, billing manager for The Center for Cancer and Hematologic Disease in Cherry Hill, N.J. To meet code requirements, the infusion (whether continuous or intermittent) must last a minimum of eight hours. Because the patient leaves the office for the duration of the infusion, -it is only possible to document the time of initiation, not completion- says Lisa S. Martin, CPC, CPC-INTMED, with Illinois CancerCare, P.C. -When the patient presents for the pump disconnect, the record should then reflect the time of disconnect.- Additional documentation: -The medical records should include a treatment plan that indicates how long each pump should run,- Martin -- who is also an independent coding educator and consultant and AAPC-approved instructor -- continues. -In addition, it is helpful for each patient's record to contain a -pump recipe- documenting the cc's of the drug and any fluid additives, and stating the rate at which it should run.- An example of nursing documentation for pump initiation might say: -Fluorouracil 3521 mg (at 2160 mg m/2)(of 50 mg/ml) intravenous once continuous over 46 hours in NS 96.6 ml. Start time June 26, 2008 13:50,- Matola offers. Important: Medicare and other payers will not cover portable or disposable pump use for all medications. Generally, only those drugs (such as 5FU, J9190, Fluorouracil, 500 mg) that require long-term infusion to prevent tissue necrosis and other side effects will call for 96416. In contrast, because providers may safely administer saline or heparin using standard infusion techniques, you would not report 96416 (which is reserved for chemotherapy) for these. If you administer non-chemotherapy drugs via pump, you must report an unlisted procedure code such as 90799 (Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion). Call on E codes for Pump Supply If your oncology practice rents or owns the portable pump that a patient uses for prolonged infusions, you may report an appropriate HCPCS code for the pump's cost to your DMERC. For infusions of eight hours or [...]