Oncology & Hematology Coding Alert

Question: Were there any new CCI edits for chemotherapy in the latest update for physicians?

Illinois Subscriber

Answer: A few new Correct Coding Initiative (CCI) edits went into effect April 1, 2011, for chemotherapy codes. The edits prevent you from reporting 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive]) with the following chemotherapy codes:

• 96405 -- Chemotherapy administration; intralesional, up to and including 7 lesions
• 96406 -- ... intralesional, more than 7 lesions
• 96440 -- Chemotherapy administration into pleural cavity, requiring and including thoracentesis
• 96450 -- Chemotherapy administration, into CNS (e.g., intrathecal), requiring and including spinal puncture.

The chemotherapy codes are in column 1 and 37202 is in column 2. The edits have a modifier indicator of 1, so you may report them separately (by appending an appropriate modifier) when the services are distinct and the documentation supports that distinction. If you report both codes and don't append an appropriate modifier, Medicare will pay only the column 1 code.