Oncology & Hematology Coding Alert

If your oncology practice expects you to report 99211 and other E/M codes for dispensing oral leukemia drugs, then you'll need to become detail-oriented. When your physician documents the correct details, you'll find it easier to submit proper codes that Medicare and other carriers will be hard-pressed to deny.
 
CPT doesn't list a specific code for your oncologist administrating oral chemotherapy to treat chronic myeloid leukemia (CML, 205.1), and you cannot submit oral anti-cancer drugs with HCPCS J codes. But you can code and report the E/M services your oncologist or nurse performs when dispensing the drug. And you can receive payment from your durable medical equipment regional carrier (DMERC) for the drug.
 
Here's an example: Your nurse gives Busulfan to treat CML, provides counseling about the drug's side effects and answers the patient's questions. To receive reimbursement for the nurse's work, you should report a nurse-only visit, 99211 (Established patient, office or other outpatient visit). Instruct your nurse to document that he or she evaluated the patient. The documentation should support your listing 99211 in case the carrier audits your practice or requests additional support for your claim.

Report Busulfan's NDC for Payment

To bill DMERC for Busulfan, you must report the drug's National Drug Code (NDC), 00173-0713-25;
ICD-9 code 205.1; your oncologist's name and physician identification number (PIN); and the number of tablets dispensed to the patient.
 
If the patient has an adverse reaction to the drug, you should report a higher-level E/M service for your oncologist's treatment. For example, a CML patient who takes Busulfan presents to your office with a sore throat (462), dizziness (780.4), and a rash on her neck (782.1). Your oncologist examines the patient and diagnoses the condition as dermatitis (693.0 ... due to drugs and medicines). Your physician also includes E933.1 (Antineoplastic and immunosuppressive drugs).

Code E933.1 shows that Busulfan caused the patient's symptoms, says Karen Scott, RHIA, CCS-P, CPC, associate professor of Health Information Management, University of Tennessee Health Science Center in Memphis. Without that code, you can't show a link between the symptoms and the Busulfan.
 
For example, an established patient presents to your physician complaining that she developed a rash on her neck and torso the day after taking Busulfan. Also, she reports dizziness and a sore throat. After reviewing the systems, your physician finds the rash consistent with a Busulfan reaction and prescribes antibiotics and rash cream. 
 
You could code this office visit as either 99213 or 99214, Scott says. If, however, the patient has less severe reactions, such as fatigue only, your nurse will monitor the patient, and you should not report a higher-level E/M service than 99211.
 
Remember that you cannot report telephone E/M codes 99371-99373 if your nurse makes follow-up phone calls to monitor that patient's status. But the nurse should note the calls along with the patient's response. Medicare and other carriers do not reimburse for follow-up phone calls because a provider must treat a patient face-to-face to charge for an E/M service.