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Oncology & Hematology Coding Alert

Units of Service:

+96367: Frustrating Frequency Edit Is on the Way Out

Published on Thu Mar 15, 2012

Plus: Allowed Anzemet units take a dive. Here's why. If you're dealing with denials for sequential therapeutic infusions or anti-nausea medications, don't miss these two Medicare-related updates. 1. Decide How to Handle +96367 Claims You're in good company if you've been wondering why you're getting denials for more than three units of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/ substance, up to 1 hour [List separately in addition to code for primary procedure]). The cause is a medically unlikely edit (MUE) of 3 for the code, effective Jan. 1, 2012, as explained in Oncology & Hematology Alert, vol. 14, no. 3. An MUE is a frequency edit that applies to Medicare claims via the Correct Coding Initiative (CCI). Good news: CCI will change the MUE for +96367, announced the Community Oncology Alliance (COA) on its website (http://communityoncology.org/article- Coding-Help-on-MUE-Relating-to-CPT-Code-96367.aspx). [...]
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