Oncology & Hematology Coding Alert

Question: Is there a limitation to how many times I can bill 90772 per visit? Our office billed for three injections during a single visit using 90772-59, but Medicare declined payment for the third injection calling it a duplicate.

Oregon Subscriber

Answer: In cases such as yours, payers typically request that you use units to represent multiple services. For example, report 90772 x 3 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Some carriers will not reimburse for two or more line items of a single code.

Remember: Only bill using modifier 59 (Distinct procedural service) if you-re billing for a different administration method.

Example: If the oncologist administers chemotherapy and an unrelated injection, your payer may request that you report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and 90772-59. Correct Coding Initiative (CCI) edits bundle 90772 into 96413, but the "1" modifier indicator on the bundle indicates that you may override the edit when the procedures are truly distinct.

Important: In this situation, you cannot report modifier 59 without written payer authorization. A number of insurers bundle 90772 into other administration services.

Modifier 59 is under constant scrutiny from auditors, so be sure you meet the strict requirements for this modifier before using it.

You can find more details on proper use at http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf.