Oncology & Hematology Coding Alert

Question: An anesthesiologist worked with the oncologist on a case involving a lumbar puncture and intrathecal chemotherapy. The anesthesiologist completed the lumbar puncture, and the oncologist completed the chemotherapy administration. Code 96450 includes both services, so we tried filing with modifier 80 and modifier 62. The payer denied everything. How should we report the procedure?

North Carolina Subscriber

Answer: The oncologist should submit 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture) with modifier 52 (Reduced services) to indicate the he didn't perform the full service as defined by the code definition.

The Medicare Physician Fee Schedule does not allow modifier 62 (Two surgeons) with 96450. Technically, Medicare allows modifier 80 (Assistant surgeon) with 96450 if you submit documentation to support your coding. However, in the case you describe the "assistant surgeon" modifier doesn't fit. Modifier 80 is appropriate when one surgeon assists the other with multiple portions of the case rather than completing his work independently.