Medicare Compliance & Reimbursement

The answer is hiding in carriers' local coverage decisions.

The Centers for Medicare and Medicaid Services is passing the buck on so many drug administration-coding issues that getting familiar with local carrier policy is becoming necessary.
 
In a new set of Frequently Asked Questions on drug administration codes, CMS says it's up to the Part B carriers to decide such tricky questions as:

Can providers bill for a concurrent infusion (G0350) if they provide two drugs in the same bag to a patient? CMS says it's reviewing this issue, but in the meantime the carriers can come up with their own definition.

Which non-chemotherapy drugs can providers bill using the chemotherapy administration codes? Besides parenteral administration of nonradionuclide anti-neoplastic drugs and anti-neoplastic agents treating non-cancer diagnoses, CMS has specified five monoclonal antibodies that providers can bill using the chemotherapy codes.

But CMS now says that list isn't intended to be complete. CMS reports it "will continue to defer to the local carriers to decide which drugs may be billed under the chemotherapy administration codes."

When providers provide the same drug twice, by different methods of administration, such as an infusion in the morning and an injection later in the day, can they bill more than one administration code? CMS says that this is up to the carrier.