Oncology & Hematology Coding Alert

Question: Are people billing for pre-meds using the non-chemotherapy administration code? For administration over 15-20 minutes, can I bill the "up to an hour" code? Will 15 minutes comply?

California Subscriber

Answer: Medicare allows a separate payment for infusions of antiemetics, steroids and other drugs if the infusion precedes or follows the chemotherapy administration, but not if these medications are administered at the same time as the chemotherapy administration. You can indicate that the infusion was before or after the chemotherapy administration through the use of modifier -59 (Distinct procedural service) added to the non-chemotherapy infusion codes (90780-90781). Medicare also allows a separate payment for infusion of saline solution (hydration) prior to and after chemotherapy administration when therapeutically necessary. Again, add modifier -59 to the infusion code (90780-90781) to indicate that the hydration occurred before or after the chemotherapy administration.

It is essential to clearly document start and stop times for all infusion services, both chemotherapy and non-chemotherapy. It is also important to document time for these services separately, showing chemotherapy start and stop times, and hydration or pre-med start and stop times.

90780 is defined as infusion "up to one hour." This code is generally used literally for any medically necessary and clearly documented infusion time up to one hour. 90781 is used for "each additional hour." Common practice is that after the first hour, service times are rounded up or down to the nearest hour. If infusion services are provided both pre- and post-chemotherapy, all times should be added together for billing purposes, and the total time should be indicated on the claim form.

One additional caution regarding infusion codes: The time measured includes only the time of the infusion itself. Time spent preparing the drug and other time spent before and after the infusion are not counted.

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.