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Gastroenterology Coding Alert

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Some Drug Admin Edits Revoked Retroactive to April

Published on Tue May 10, 2005

Use modifier -59 to overturn edits before July 1

If your gastroenterology office is reporting additional sequential IV pushes with chemotherapy or other drug administration codes, your life just got a lot easier.
 
The Centers for Medicare & Medicaid Services  announced it will revoke five controversial edits governing drug administration code G0354 (Each additional sequential intravenous push). The National Correct Coding Initiative version 11.1, implemented April 1, bundled G0354 with five codes:
 

  • G0345 - Intravenous infusion, hydration; initial,  up to one hour
     
  • G0347 - Intravenous infusion, for therapeutic/diagnostic; initial, up to one hour
     
  • G0357 - Intravenous, push technique, single or initial substance/drug
     
  • G0359 - Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug
     
  • G0361 - Initiation of prolonged chemotherapy infusion (more than eight hours), requiring use of a portable or implantable pump.

    But NCCI version 11.2, which takes effect July 1, will delete those edits retroactive to April 1.
     
    Until that change takes effect, you can use modifier -59 (Distinct procedural service) "to indicate that there was a separate sequential infusion of a different drug or the same drug at a different time," CMS says. Or you can just wait until after July 1 to submit claims from May or June, and the carriers won't apply the edits at all. 

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