Oncology & Hematology Coding Alert

Question: Can I claim 36410 and 90774 if the patient presents weekly for flushing an external catheter? Arizona Subscriber Answer: Most likely, no. The AMA instructs, "codes 36410 [Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)] and 90774 [Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug] should not be reported for the -flushing- of either a long-term central venous access device or an implanted venous access device port. "This procedure, when performed by the physician during an office visit is included in the appropriate level of evaluation and management service" (CPT Assistant, October 2003). In other words: You should include the port flush as part of any E/M service the physician performs. For port flush that occurs either before or after chemotherapy administration, you-d include the flush as part of the overall service. Medicare, however, may reimburse you for 96523 (Irrigation of implanted venous access device for drug delivery systems) if irrigation/port flush is the only service the oncologist provides that day.