Oncology & Hematology Coding Alert

Question: What code should I use to bill for patients who present to the clinic setting that is to say, when there is no physician on staff in the clinic for maintenance of venous access devices in between chemotherapy/transfusion visits, or after the chemo visits are completed? Should I use office visit E/M codes 99211-99215 or 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous) for injection of saline or heparin for patency?

California Subscriber

Answer: A port flush is a procedure that many carriers will not pay for because it is considered maintenance therapy. In these common cases, the only option you have left is to bill E/M code 99211 for this visit. You can also bill for the supplies and drugs used to complete the port flush. Many of these supplies and drugs are not reimbursable by Medicare but may be reimbursable by other carriers.

The access needle A4212 (Non-coring needle) may be covered by Medicare but is at the discretion of the carrier. 99070 (Supplies and materials, provided by the physician over and above those usually included with the office visit or other services rendered) can also be billed. You can also bill for the heparin and saline used submit J1642 (Injection, heparin sodium, [Heparin Lock Flush]), usually 10 billing units or 100 units total, and J7051 (Sterile saline or water, up to 5cc), usually two billing units or 10cc total. J7051 is also reimbursable at the carrier's discretion.

Answers to the Reader Questions and You Be the Coder were provided by Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett; and Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.