Oncology & Hematology Coding Alert

Oncologists are equipping more of their patients with ambulatory infusion pumps that administer chemotherapy outside of the office. The supplies associated with these pumps are usually reimbursable, but billing for the pumps themselves must be done carefully. You have to take into account where and when the pumps are used and whether the oncology practice owns or rents them.
 
Depending on several factors, practices should use either chemotherapy administration codes 96410-96423 (the series that describes infusion pumps) or E codes, but never both, says Riise Cleland, CPC, president of Oplinc Oncology Services, a coding consulting firm in Lawton, Okla.
Billing for Ambulatory Pumps Used at Home  
Oncology practices commonly fill patients' pumps, provide instructions on their use,  send patients home to self-administer the first dose of chemotherapy, refill subsequent doses, then disconnect the pump when therapy is completed.
 
In these cases, Medicare considers administration of the chemotherapy agent self-administered, so you must bill the appropriate E code and the cost of the drug to your durable medical equipment regional carrier (DMERC). Oncology practices that own or rent ambulatory pumps for patient home use should report the following E codes:  
E0779 -- ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
 
E0780 -- ambulatory infusion pump, mechanical, reusable, for infusion less than eight hours
 
E0781 -- ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
 
E0782 -- infusion pump, implantable, non-programmable
 
E0783 -- infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)
 
E0785 -- implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement
 
E0791 -- parenteral infusion pump, stationary, single or multichannel.  
If your oncology practice does not own or rent its pumps, you cannot bill the DMERC because there are no costs to recoup. The practice initiates pump use and refills and maintains the pump. Therefore, you can report only 96414 (infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump) and 96520 (refilling and maintenance of portable pump) to Medicare for reimbursement.
 
Patients who use infusion pumps at home might need help in starting treatment. When the patient comes to the office to have the pump initiated, report 96414. If the patient requires return visits to refill the pump, the correct code is 96520. 
 
But if a practice sends a patient home with a pump without initiating it, the drug was not administered in the office so you cannot report the administration codes.  
 
Medicare's reimbursement includes the expense of acquiring and maintaining the pump. Payment for 96410-96423 encompasses these costs and those associated with nursing services and chemotherapy administration.
Billing an E/M With Infusion  
In addition to initiating the treatment, an oncology practice may bill for an [...]