Oncology & Hematology Coding Alert

Question: We recently received a provider claim communication saying the modifier we used was not valid. The claim included a drug (methotrexate) with modifier FB and an administration code. Should I have put the modifier on the administration code instead? The service was outpatient hospital because there was an Ommaya reservoir, and the hospital provided the drug.

North Carolina Subscriber

Answer: Because the hospital provided the drug, you don't need to report the drug or modifier FB (Item provided without cost). You only need to report the physician claim for the administration.
 
Example: Report 96542 (Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents).
 
Pay attention: Report place-of-service code 22 (Outpatient hospital) to indicate that the service took place in an outpatient hospital setting. This lets the insurer know that the hospital will claim drug and technical charges.
 
You won't report modifier FB in this situation because another entity is charging for the drug. You should use FB when no physician or healthcare entity charges for the drug.

 -- 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 past-president of the American Academy of Professional Coders National Advisory Board.