Oncology & Hematology Coding Alert

Question: If our nurses change the dressings on catheters a few times a week, can we code for the supplies?


Missouri Subscriber

Answer: Your payer may cover this, but look to CPT, not HCPCS, for your answer.

Instead of reporting A4221 (Supplies for maintenance of drug infusion catheter, per week [list drug separately]), which is more appropriate for drugs than dressings, report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). Only report 99070 for dressing changes that take place in the office, because hospitals report supplies based on available chargemaster entries, contributing to an increase in APC allowances.

Helpful: Medicare won't pay for 99070, but other insurers may, so on your Medicare claim, indicate that you are requesting a denial by appending the appropriate modifier to the supply code (such as modifier -GY, Item or service statutorily excluded or does not meet the definition of any Medicare benefit, or       -GZ, Item or service expected to be denied as not reasonable and necessary).

Don't forget: In addition to 99070, you can report an E/M code for this dressing change, 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...), if the nurse performs only the dressing change during the visit and the service meets incident-to requirements.

If the patient receives another service in addition to the dressing changes, you may code the supplies, but you should only report an E/M code if the documentation shows evaluation and management separate from the dressing and not included in the second service. 

The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president, AAPC National Advisory Board.