Pediatric Coding Alert

Question: May I report an office visit code in addition to hydration therapy code 90780? Many insurance companies are denying the procedure as included in the E/M service. How should I bill when we treat a chemotherapy patient?

Minnesota Subscriber

Answer: Before appealing the denials for 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour), you should check a few items:
 
1. When billing 90780 and 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour), you should append modifier -59 (Distinct procedural service) to the infusion code, as long as you provide the hydration and chemotherapy services sequentially.
 
For instance, if you hydrate the patient from 9-10 and give the chemotherapy treatment from 10:10-12, you would bill 96410, +96412 (... infusion technique, one to 8 hours, each additional hour [list separately in addition to code for primary procedure]), 90780-59. In this case, the modifier appropriately informs the payer that the hydration is separate from the chemotherapy administration.
 
Insurers may not pay for hydration therapy administered at the same time as chemotherapy based on Medicare rules that include payment in the chemotherapy codes.
  
2. You may bill for an office visit on the same day as infusion if the pediatrician provides a separate and identifiable service from the infusion. "If the patient is there for no other reason than infusion, an office visit does not qualify," states the Minnesota Society of Clinical Oncology on its "Reimbursement Questions and Answers" Web page.
 
For example, a chemotherapy patient develops nausea with vomiting and the pediatrician treats the patient. You should bill the appropriate-level office visit appended with modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). The documentation should include the proper ICD-9 code (787.01, Nausea with vomiting) and note that the physician personally treated the patient.