Oncology & Hematology Coding Alert

Question: Our office is participating in the Medicare demonstration project for chemotherapy patients. I was wondering how a properly coded claim would look for a patient the physician treats with  subcutaneous hormonal injection chemo. The patient had no nausea/vomiting, quite a bit of pain, and quite a bit of fatigue. How many G codes should I report, and which ones should I choose?


Maine Subscriber


Answer: To successfully participate in the Medicare demonstration project to measure quality of care for cancer patients undergoing chemo, you need to include three G codes: one to reflect the patient's nausea/vomiting; one for pain; and one for lack of energy (fatigue). Each of these three G code sets includes four separate codes to account for differing levels of severity.

Based on your scenario, the oncologist treated a patient with hormonal injection chemotherapy. This patient had level-one vomiting, level-three pain, and level-three lack of energy (fatigue). On your claim, you should:
 

report G0356 (Hormonal antineoplastic) for the chemotherapy
 

report G9021 (Chemotherapy assessment for nausea and/or vomiting, patient-reported, performed at the time of chemotherapy administration; assessment level one: not at all [for use in a Medicare-approved demonstration project]) for the patient's nausea/vomiting level.
 

report G9027 (Chemotherapy assessment for pain, patient-reported, performed at the time of chemotherapy administration, assessment level three: quite a bit [for use in a Medicare-approved demonstration project]) for the patient's pain level
 

report G9031 (Chemotherapy assessment for lack of energy [fatigue], patient-reported, performed at the time of chemotherapy administration, assessment level three: quite a bit [for use in a Medicare-approved demonstration project]) for the patient's lack of energy (fatigue) level.