Oncology & Hematology Coding Alert

Question: We recently started billing for a hematology/oncology group and received our first rejection for an unlisted-procedure code. We use 96549 (Unlisted chemotherapy procedure) to indicate accessing a Port-a-Cath. Which code should we use?

Illinois Subscriber
 
Answer: You may report 99211-25 (Office or other outpatient visit ... established patient; Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) if the patient presents only for a port flushing.
Otherwise, when the patient comes in for chemotherapy administration, you cannot bill for routine flushing and accessing of a Port-a-Cath, which oncologists implant under a patient's skin to deliver chemotherapy directly to the bloodstream or to retrieve blood from the bloodstream.

You may, however, bill for the supplies the physician uses to administer this service.