Oncology & Hematology Coding Alert
Bundled PFTs Cause Denials
Question: Medicare has denied our claims for pulmonary function tests that are part of the prechemotherapy workup. What can we do to get paid? Answer: Make sure you are not billing for PFTs (94010-94799) that Medicare has bundled when the physician performs them on the same date. For instance, you cannot report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) in addition to 94150 (Vital capacity, total [separate procedure]). That's because code 94010 includes vital capacity, and therefore, Medicare considers 94150 a part of spirometry.
Pennsylvania Subscriber
The final step: Make sure you are listing the correct ICD-9 malignancy code that justifies your oncologist using a PFT. For example, Blue Cross Blue Shield of Georgia will pay for spirometry when the physician is treating a malignant neoplasm of trachea, bronchus or lung (162.x).
Oncology & Hematology Coding Alert
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Question: Our payer claims IMRT procedures are investigational. How can we prove otherwise?
Texas Subscriber
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CMS Scraps 90-Day Coding Grace Period
Update your charge sheets to prevent denials
You will no longer have a 90-day grace period [...] - Reader Question:
Bundled PFTs Cause Denials
Question: Medicare has denied our claims for pulmonary function tests that are part of the [...] - Reader Question:
Watch for Consult Time Lapses
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Document Chemo Time From Start to Finish - Reader Question:
See Modifier -55, Think Postoperative Care
Question: Our oncologist recently took over the postoperative care of another surgeon's replacement of a [...] - Reader Question:
Physician Must Supervise CPO Patients
Question: How should we report our oncologist's hospice services to Medicare?
South Dakota Subscriber Answer: Typically, [...] - Reader Question:
Use ABN for Male Mammogram Patients
Question: An oncologist ordered a screening mammogram for a male Medicare patient with a family [...]
