Practice Management Alert

Medicare will use new HCPCS codes to track IV and chemotherapy

For the latest on reporting injections and infusions to Medicare, you'll need to turn to your HCPCS Level II manual.

The Medicare Modernization Act of 2003 required the American Medical Association to form a CPT Editorial Panel to revamp injection and infusion codes, says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. Although the AMA didn't finish in time for the 2005 CPT update, the Centers for Medicare and Medicaid Services felt that incorporating some changes this year was necessary, she adds.
 
What this means for you: New injection and infusion CPT codes will exist in 2006, but for this year coders and billers must use interim G codes when reporting these services to Medicare, Falbo says.

Understand the 3-Way Code Division

Medicare breaks new injection/infusion codes G0345-G0363 into three categories: infusion for hydration; nonchemotherapy, nonhydration therapeutic/diagnostic [injections and infusions]; and chemotherapy administration [infusions and injections].

Keep in mind: You can expect reimbursement from only one "initial" code per day (denoted with a * on charts), so you should choose the best code to describe the key service your physician performs - regardless of which order he performs the infusions or injections.

To the right,  are three lists of the new HCPCS codes for Medicare, and the existing CPT codes that correspond (where applicable). This information comes from the Federal Register's Physician Fee Schedule Final Rule 2005 (online at www.cms.hhs.gov/physicians/pfs/default/asp).

1. Use G0345-G0346 for hydration. The first two new G codes describe intravenous procedures focused on hydration.

2. Divide 90781 into G0348-G0350. The next set of G codes describes therapeutic or diagnostic drug administrations applicable to nonchemotherapy agents. You'll use these codes to report a therapeutic/diagnostic injection into 1. subcutaneous or intramuscular tissue or 2. the vein or artery via an IV set-up (including saline with the drug, either as an additive or injected into the IV line).

3. Choose from G0355-G0358 for chemo injections, and G0359-G0362 for chemo infusions. For accurate coding, make sure you understand the difference between a chemotherapy injection and infusion. "A chemo injection is the drug being injected directly into the skin or the vein all at once. Chemo infusion is the drug being infused over time directly into the vein and/or port intravenously," says Kelly Reibman, CPC, billing manager for Mariette Austin, PhD, MD, in Easton, Pa.