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 the following:

- initial hydration administration code 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour)

- initial therapeutic, prophylactic or diagnostic injection code 90774 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug)

- initial chemo push code 96409

- initial chemo infusion code 96413.

Myth 3: Always Use 96409/90774 When Push Is First

Myth 3 is related to Myth 2. Remember: You should choose your -initial- service code based on the primary reason for the encounter, not the administration order.

Smart: Double-check your documentation before you report 96409 or 90774 because the push will rarely qualify as the primary reason for the patient encounter when providers administer multiple drugs via different administration methods in a single encounter, Parman says. A chemotherapy infusion trumps a push and will generally be the primary reason for the visit, she says.

Example: The patient receives an antiemetic push followed by a 5FU infusion. The 5FU therapy is the primary reason for the patient encounter, so you should report the infusion as the initial code (96413) along with 90775 for the push.

Myth 4: Report 2 Units for 2 Pushes of 1 Drug

Multiple pushes of one antineoplastic drug equal one unit of 96409 because one substance equals one unit,  Parman says.

Why: Push code descriptors specify that each code describes a single substance administration. For instance, the 90775 descriptor states, -each additional sequential intravenous push of a new substance/drug.- Result: If the patient receives two pushes of the same antiemetic during a patient encounter, you would report one push code unit for the one drug or substance administered.

Myth 5: Claim Concurrent Code for Infusion/Push

Two infusions administered at the same time may be a concurrent infusion, but a push administered during an infusion is still a push and an infusion. Translation: Don't report a concurrent infusion code for a push administered during an infusion.

Example: If the provider sets up a saline -flush bag,- connects Zofran to the flush bag, and infuses the Zofran for 30 minutes and then pushes Dexamethasone (Dex) through the same flush bag, you would report:

- Zofran infusion: 90765

- Zofran drug: J2405 (Injection, ondansetron HCl, per 1 mg)

- Dex push: 90775

- Dex drug: J1100 (Injection, dexamethasone sodium phosphate, 1 mg).

Providers don't have to -stop- the infusion when they administer a push, so you can report the entire infusion time and report the push separately.