Oncology & Hematology Coding Alert

Question: If we give a patient 5-FU in the office and then send the rest home in a pump, should we report this all as office?

Ohio Subscriber

Answer: If you own the pump, you should report the 5-FU given in the office to your Part B carrier and the pump 5-FU to the DMERC (Durable Medical Equipment Regional Carrier). The appropriate code is J9190 (Fluorouracil, 500 mg). If your office owns the pump, use HCPCS code E0779 (Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater) to report the pump rental to the DMERC, though most practices contract with a vendor that supplies the pump and bills the DMERC
 
Example: You're treating a patient for stage III sigmoid colon cancer (153.3, Malignant neoplasm of colon; sigmoid colon). At the office, you give him a loading dose of 5-FU (400mg/m2) IV bolus.
 
Report one unit of J9190 as office.
 
You then connect the patient to a pump in the office, and he goes home with the pump set to infuse the drug for a specific time, amounting to 2,500 mg/m2.
 
For the pump infusion outside the office, you should report five units of J9190 to your DMERC.
 
Don't forget: You need a separate provider number to report to the DMERC, though this extra step should be eliminated when health plans allow you to start using the new National Provider Identifiers (NPI). All health plans will have to use these beginning in 2007-2008. (Note: You can read more about the NPI at www.cms.hhs.gov/medlearn/npi/npiviewlet.asp.)
 
If your DMERC denies the claim as a duplicate, absolutely request a review, or you're throwing money down the drain. Explain that the drug was delivered in two separate locations, with two different forms of administration to prove that you are reporting correctly.
 
Helpful: As always, be sure you double-check all the details. Review your payer's medical-necessity guidelines and don't forget to report place of service code 12 to the DMERC to indicate the pump's use in the patient's home.

 - 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.