Oncology & Hematology Coding Alert

Question: I am having trouble getting reimbursed for 90784. Medicare states that it is not paid separately. How do we get paid for this procedure? Should we use modifier -59?

Alabama Subscriber

 
Answer: Codes 90782-90788 (therapeutic, prophylactic or diagnostic injections) are used when a drug such as epoetin alpha, Q0136, is used to combat anemia caused by chemotherapy. These drugs can be administered either at the same time as chemotherapy or separately from chemotherapy.
 
Coding for epoetin alpha varies from state to state, so providers should ask their local carriers for guidelines for this drug.
 
Medicare carriers will not reimburse oncology practices for the injection if it was done on the same day as chemotherapy administration and done by the same provider. Instead, the physician can bill only for the drug. Codes 90782-90788 are bundled with chemotherapy administration.
 
If the procedure was done the day after chemotherapy,  90782-90788 can be coded separately because it is independent of the previous days chemotherapy administration. But if the procedure was done on the same day as an E/M visit, the practice may bill only the E/M service. 
 
Using modifier -59 (distinct procedural service) with 90784 is not appropriate because the injection code is never payable with chemotherapy administration or E/M services. Modifier -59 may be used with 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and +90781 (... each additional hour, up to eight hours).
 
To code this separately, the infusion of the non-chemotherapy drug must be done separately from or sequentially of chemotherapy administration. To prove that the support-care drugs and chemotherapy were provided sequentially, practices must ensure that the patient record reflects the times the drugs were delivered.