Oncology & Hematology Coding Alert

Question: How should we bill 2 mg of Activase when the HCPCS code (and Medicare allowable) is for 10 mg?

Colorado Subscriber

Answer: The new HCPCS code is for 1 mg., not 10 mg.: Code J2997 (injection, alteplase recombinant, 1mg). Last years HCPCS listed J2996 (injection alteplase recombinant, 10 mg) as the code to report the use of Activase. You should bill J2997 twice to report the administration of 2 mg of Activase.

Some providers, however, are reporting that they have been getting paid for Activase by reporting J3490 (unclassified drug). Code J3490 is an all purpose code: billing must include the name of the medication when this code is used. The apparent discrepancy underscores the importance for providers to check with their local carriers and commercial payers for their individual coding guidelines.

The larger issue, however, is which codes to use when administering the drug through a venous access device, such as a partially or completely implanted catheter. Activase is used to flush the implanted device used to administer chemotherapy and other drugs related to chemotherapy treatment, and to keep venous access for blood samples.

Medicare allows providers to bill for the following:

A4300 or A4301 implantable access catheter [venous arterial, epidural or peritoneal],external access; implantable access total system,catheter, port/reservoir[venous, arterial or epidural], percutaneous access;

36533 insertion of implantable venous access device, with or without subcutaneous reservoir; and

99211 office or other outpatient visit.

Use of 99211 is dependent on whether the flushing of the port is a separate and distinct service. In other words, whether the maintenance of the port is part of chemo-therapy treatment or a higher-level E/M. If so, oncology practices should bill the higher-level visit, 99212-99215, and consider the port flush as part of the visit.