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Oncology & Hematology Coding Alert

You Be the Coder:

Do Not Forget Incident-To Services

Published on Thu Dec 04, 2014

Question: A patient diagnosed with reticulolymphosarcoma in the inguinal lymph nodes presented with pain in shoulder and neck and tingling in the fingers. The patient had a history of degeneration in the disc of cervical spine. Our physician flushed the Mediport per protocol and the patient reported no problems. The patient was asked to follow up again within four weeks. The flushing was done in office setting. Please guide on how to report this procedure. Can we expect reimbursement for this procedure? Are the requirements for incident-to met for this encounter? How can we report the diagnosis of reticulolymphosarcoma in the inguinal lymph nodes?

New York Subscriber

Answer: Your physician performs a Mediport flush for the patient. You submit code 96523 (Irrigation of implanted venous access device for drug delivery systems). But beware, you should notice the note following the CPT® code indicating “(Do not report 96523 in conjunction with other services. To report collection of blood specimen, use 36591).”  Therefore if the physician has also not reported any other services, you can expect reimbursement for the Mediport flush. However, if other services were provided and reported, you would not independently report the Mediport flush. 
 
For the diagnosis of reticulolymphosarcoma in the inguinal lymph nodes, you look up reticulolymphosarcoma in the index. You will be referred to 200.8 (Other named variants of lymphosarcoma and reticulosarcoma). This code needs a fifth digit based on location. Since your physician has documented reticulosarcoma in the inguinal nodes, you report this with a fifth digit of “5.” Hence the most appropriate code is 200.85 (Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of inguinal region and lower limb).
 
Check criteria for incident-to service: Did you meet requirements for incident-to in this case? To be covered incident-to the services of a physician or other practitioner, services and supplies must be:
  • An integral, although incidental, part of the physician’s professional service
  • Commonly rendered without charge or included in the physician’s bill
  • Of a type that are a commonly furnished in physician’s offices or clinics
  • Furnished by the physician or by auxiliary personnel under the physician’s direct supervision.

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