Oncology & Hematology Coding Alert

Several categories of items and services should be billed in connection with external pumps. Oncology consultants typically include the following categories:

In the case of a stationary pump, use E0776 (IV pole) for an IV pole if one is rented to the patient. E0791 (Parenteral infusion pump, stationary, single or multichannel) is used for stationary pumps in the patient's home.

Other applicable HCPCS codes for ambulatory pumps:

E0781 (Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient) applies to electrical pumps carried by the patient, while E0779 (Ambulatory infusion pump, mechanical, reusable, for infusion eight hours or greater) and E0780 (Ambulatory infusion pump, mechanical, reusable, for infusion less than eight hours) are used for refillable nonelectric pumps carried by the patient. Remember, experts tell oncology billers, if your oncology practice does not own or rent its pumps, you cannot bill for them because there are no costs to recoup.

You may bill A4211 (Supplies for self-administered injections) and A4222 (Supplies for external drug infusion pump, per cassette or bag [list drug separately]) for the disposable supplies. A4211 is a weekly charge for supplies used for maintenance of the port of an epidural catheter. A4222 is used to bill the supply cost for each bag or cassette furnished to the patient. These codes can be billed even if the oncologist also reports codes for initiation or refilling of the pump, Hickey says.

When you report the initial filling of a pump in the physician's office, either 96414 (intravenous) or 96420 (intra-arterial) is the only code that would apply:

The appropriate maintenance code (not to be used for routine accessing and flushing of the implanted port or central catheter) is 96520 (Refilling and maintenance of portable pump).

Many oncology practices do not provide the pumps but rather get them from a local DME supplier, including those who specialize in infusion pumps, Hickey says. Often the DME supplier provides the cassette or bag, and specialized pump tubing along with the pump. The oncology practice then fills the bag with the chemotherapy agent and initiates or maintains the infusions. In this case, Hickey reminds readers, "the oncology practice can only bill for the appropriate infusion initiation code or refilling and maintenance code."

If the oncologist provided evaluation and management services on the day that the pump was initiated or refilled, you may bill an appropriate E/M code. Remember that port flushing is included in the appropriate office code - normally 99211 (Office or other outpatient visit ...) because a nurse performs it under physician supervision as an incident-to service. If a patient comes to the office for the sole purpose of having a pump unhooked by a nurse, a level-one visit is allowable, Hickey says.

Implanted pumps fall under notably different drug coverage rules than do external pumps. For implanted pumps, the only chemotherapy regimen covered by Medicare under national policy is for intra-arterial infusion of 5-FUDR (J9200) for the treatment of liver cancer (155.0-155.2) in patients with primary hepatocellular carcinoma or Duke's Class D colorectal cancer (153.0-153.9). In these patients, the metastases must be limited to the liver and the disease must be unresectable or the patient must have refused surgical removal of the tumor.

Medicare also covers opioid drugs (such as morphine) administered through an implanted pump intrathecally or epidurally, but only for the treatment of intractable pain in patients who have a life expectancy of at least three months and who have proven unresponsive to less invasive pain management.

According to Medicare, an implanted infusion pump is considered to be DME. Therefore, send bills for filling the pump not to your DMERC but to a local carrier.

Applicable HCPCS codes for ambulatory pumps: E0782 applies to non-programmable implanted pumps, while E0783 is used for all components of a programmable pump. If, for any reason, the pump requires replacement, use E0785.

If the pump initiation is performed in the office and the patient is sent home to complete the treatment, use the code for intra-arterial, push technique - 96425 (... infusion technique, initiation of prolonged infusion [more than eight hours], requiring the use of a portable or implantable pump). The maintenance code is not to be used for port flushing; rather, the routine accessing and flushing of the implanted port or central catheter is included in the appropriate office code  normally 99211 because a nurse performs it under physician supervision as an incident-to service. Report 96530 (Refilling and maintenance of implantable pump or reservoir) for refilling.

There is no uniform national policy regarding whether Medicare makes a separate payment to refill kits used in connection with implanted pumps. If they wish, carriers have the option to treat these supplies as covered by the payment for refilling under 96530. Alternatively, Hickey says, some carriers may treat the entire refill kit (or portions of the kit, such as fenestrated drapes, pressure gauges and templates) as DME, thus making is eligible for a separate Medicare payment. Since these decisions are made at a local level, be sure to research your carrier's LMRP for refill kits.

If an oncologist administers chemotherapy infusion for fewer than eight hours through a pump, this service must be coded and billed as a nonpump infusion using 96412, not the pump codes. The information in this article is relevant only to pump infusions lasting eight hours or longer.