Oncology & Hematology Coding Alert

Steer clear of this common concurrent coding misdeed Reporting push codes often requires you to choose between an -initial- code and a -subsequent- code, but that may not be easy. Simplify your coding options with the reality behind these five coding myths. Myth 1: Count to 15 for Every Push Most pushes you see may last less than five minutes, but time is not the only indicator of a -push,- according to oncology coding expert Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies in Powder Springs, Ga., in her presentation, -Hospital Infusions and Injections,- at the 2007 national American Academy of Professional Coders conference in Seattle.

You need documentation meeting only one of the criteria to report a push code, whether you code for hospitals or physician offices.

Key: According to CPT guidelines, an intravenous or intra-arterial push is either of  the following:

1. an injection in which the administering healthcare professional is continuously present, or

2. an infusion lasting 15 minutes or less.
 
Example 1: If the nurse performing the administration is continuously present during a 20-minute injection, consider this a -push,- Parman says.

Example 2: If the nurse hangs a minibag administered over a 13-minute period, report this with a -push- code, Parman says. Myth 2: Report Initial Push/Initial Infusion Together Don't be tempted to report an initial push code automatically for the first push a patient receives during an encounter alongside an initial infusion code for the first infusion.

Reason: When you choose your -initial- service code, base your decision on the primary reason for the encounter, says Washington oncology coder Sharlene Evans, CPC, CPC-H. That means you should report one initial code per encounter on your claim.

Example: A note with subsequent chemotherapy push code +96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug) instructs you to report it alongside initial chemo push code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) or initial chemo infusion code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

Exception: CPT guidelines instruct you to report two initial codes in one very specific case -- when protocol requires providers to use two separate IV sites. Be sure the provider clearly documents this exception in the patient medical record, Parman says.

Don't miss: The guidelines also say you should select subsequent, sequential and concurrent service codes regardless of whether the initial service code appears in the -Chemotherapy Administration- section or the -Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions- section of the CPT manual.

Example: A note with subsequent therapeutic, prophylactic or diagnostic injection code +90775 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug) instructs you to use it with any of [...]