Oncology & Hematology Coding Alert

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: While not explicitly stated, it appears the service required a visit to evaluate shoulder/neck pain and tingling in the fingers complaint. This resulted in the physician performing a Mediport flush. If a visit was performed and documented, only the appropriate E/M code would be reported. If the encounter only resulted in the Mediport flush without a visit, submit code 96523 (Irrigation of implanted venous access device for drug delivery systems).

This is because while the flush is identified (96523), a note following the CPT^® code indicates “(Do not report 96523 in conjunction with other services. To report collection of blood specimen, use 36591).” Therefore, if the physician has not reported any other services, you can expect reimbursement for the Mediport flush. However, if other services, such as an E/M visit, were provided, documented and reported, you would not independently report the Mediport flush with the E/M visit.

For the diagnosis of reticulolymphosarcoma in the inguinal lymph nodes, if you look up reticulolymphosarcoma in the index, you won’t find this term. According to the National Cancer Institute, reticulolymphosarcoma is “Hodgkin lymphoma, lymphocyte depletion, reticular is a subtype of Hodgkin lymphoma lymphocyte depletion, characterized by extremely large numbers of Hodgkin and Reed-Sternberg cells, some of which appear to be mummified.” And “This neoplasm is now very rarely diagnosed, and it is recognized that many cases previously diagnosed as HD (lymphocyte-depletion) are in fact examples of non-Hodgkin’s lymphoma, commonly of anaplastic large cell type Anaplastic Large Cell Lymphoma.” Therefore, look in the index for lymphoma, non-Hodgkin, specified NEC which leads to C85.8-. When reviewing the codes under C85.8- in the tabular list, you will find C85.85 (Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb).

Services personally performed by the physician are not ‘incident to’ services. If the patient first saw the physician to be evaluated for the presenting symptoms, then as stated above the E/M would be reported as performed and documented and not the flush. If the patient’s complaint was not addressed by the physician and the patient only saw the ancillary clinical staff and received a Mediport flush, then check the criteria for ‘incident-to’ were met before reporting.

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.

Editor’s Note: For full incident-to information, check out the article “Follow This Expert Advice for Smart Incident-To Billing” featured in Oncology Coding Alert, volume 21, number 3.