Ob-Gyn Coding Alert

Report only one 'initial' code per day, regardless of infusion order

This year, you'll need to change the way you report your IV and chemotherapy codes - from CPT to HCPCS codes - when submitting claims to Medicare.
 
CMS expects ob-gyn offices to start using new G codes for reporting injections and infusions as of Jan. 1. (Remember, there's no more grace period.)
 
So if you're only noting 2005 CPT changes, then you're only fighting half the battle. You should also make sure your ob-gyn office keeps abreast of all the Medicare HCPCS Level II changes as well.

Don't Change How You Report Some Codes

Before you rush off to change the way you've been coding all injection and infusion procedures for Medicare, make sure you note that some related CPT codes do not change.
 
For instance, this news shouldn't affect the way you report 90799 (Unlisted therapeutic, prophylactic or diagnostic injection) or intralesional, intra-arterial, and intra-cavitary chemotherapy codes 96405-96406, 96420-96425, 96440-96542. Payment for these codes also does not change significantly.

Medicare Breaks G Codes Into 3 Categories

The best way to wrap your mind around these new G codes is to understand the rationale behind them.
 
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]. CMS will use the information gathered from these codes to keep close track of the types of administration various practices use.
 
You should report these new G codes for the year 2005 only, because CPT will release replacement codes in 2006. For example, you can already expect that CPT will delete 90788 (Intramuscular injection of antibiotic [specify]), but for now, you can still use 90788.
 
Heads-up: You can also expect reimbursement from only one "initial" code per day (denoted with a * below), so you should choose the best code to describe the key service - regardless of the order in which the ob-gyn performs the infusions.
 
Here are four lists of the new HCPCS codes for Medicare, and the existing procedure codes that correspond (where applicable). Data come from Federal Register's Physician Fee Schedule Final Rule 2005. (Editor's note: You can find it online at www.cms.hhs.gov/physicians/pfs/default.asp.)

Choose From G0345-G0346 for Hydration

The first two new codes describe intravenous (IV) procedures focused on hydration. These codes apply to prepackaged fluid and electrolytes (such as saline).

---

New HCPCS Code   G0345* (Initial infusion, up to one hour) 

Existing CPT Code   90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour)

---

New HCPCS Code  G0346 (Each additional hour) 

Existing CPT Code   90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure])

---

 
For example, if the ob-gyn administers the IV for hydration purposes prior to a non-concurrent chemotherapy infusion, then you can add modifier -59 (Distinct procedural service) to the hydration code (G0345 or G0346).
 
You can predict about $65 in reimbursement for G0345 and $21 for G0346, based on national averages. These amounts are less than their 2004 CPT code counterparts - in the case of 90780, about $55 less.
 
90781 Breaks Into G0348-G0350

When you get ready to code for 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), you'll have to use the appropriate G code.
 
This next set of codes describes therapeutic or diagnostic drug administrations, applicable to non-chemotherapy agents. They are:

---

New HCPCS Code   G0347* (Initial infusion, up to 1 hour therapeutic/diagnostic)

Existing CPT Code   90780

---

New HCPCS Code G0348 (Each  additional hour)

Existing CPT Code  90781

---

New HCPCS Code  G0349 (Each sequential infusion, up to 1 hour)

Existing CPT Code   90781

---

New HCPCS Code  G0350 (Concurrent infusion)

Existing CPT Code   N/A

---

New HCPCS Code  G0351 (Injection, single/initial, therapeutic/diagnostic) 

Existing CPT Code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular)

---

New HCPCS Code G0352 (Injection,  intra-arterial)  

Existing CPT Code 90783 (... intra-arterial)

---

New HCPCS Code  G0353* (IV push,  therapeutic/diagnostic) 

Existing CPT Code 90784 (... intravenous)

---

New HCPCS Code  G0354 (Each additional push)

Existing CPT Code   N/A

---

For example, if the ob-gyn administers an antiemetic (anti-nausea) before chemotherapy but after a hydration IV, you should report this service using an "additional sequential" therapeutic/diagnostic code, such as G0349.
 
Again, your practice may feel the sting of decreased reimbursement - especially for G0347, which returns $80 rather than the $120 associated with 90780. However, not everything decreases. You may find a little consolation in that you'll earn $10 more for G0353 and $28 more for G0354, based on national averages.
 
Note: You can now report non-chemotherapy injections and IV pushes separately, even when you report another service the same day. Therefore, codes G0351-G0354 are eligible for separate payment.

G0355-G0358 Describe Chemo Injections

You'll have to change the way you report chemotherapy drug administration codes in 2005, but make sure you know the difference between chemo injection and infusion because different codes apply.
 
Chemo injection definition: "An injection is a forceful, direct introduction of a drug or other fluid into the patient's bloodstream or body tissues," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga. If that "drug or fluid" is a chemotherapy agent, you should take note of the new HCPCS codes for this situation.
 
Chemo injection (and IV push codes) are as follows:

---

New HCPCS Code   G0355 (Injection, chemotherapy,  non-hormonal) 

Existing CPT Code  96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia)

---

New HCPCS Code  G0356 (Injection, chemotherapy, hormonal)  

Existing CPT Code   96400

---

New HCPCS Code   G0357 (IV push, single/initial, chemotherapy) 

Existing CPT Code  96408 (Chemotherapy administration, intravenous; push technique)

---

New HCPCS Code   G0358 (Each additional push) 

Existing CPT Code   96408

---

When a nurse (or ob-gyn, depending on the situation) injects chemotherapy drugs into a patient either subcutaneously or intramuscularly, you should report the procedure with G0355 (Injection, chemotherapy, non-hormonal). Don't forget to assign the appropriate J code for the chemotherapy drug(s) on your claim.
 
For example: A patient with breast cancer reports to the office for treatment. The ob-gyn subcutaneously delivers 40 milligrams of the anti-cancer drug Taxotere. On the claim you should:
 

report G0355 for the injection
 

report J9170 (Docetaxel, 20 mg) x 2 for the drug supply.

Tip: If the nurse or ob-gyn administers multiple drugs during a single injection, report G0355 only once but include the HCPCS J codes for each drug delivered.

Look to G0359-G0362 for Chemo Infusions

You could easily confuse chemotherapy injections and infusions (new HCPCS codes G0359-G0361), especially if you're reading an especially large or messy procedure note or flow chart. However, if you want your coding to be accurate, you must remember to keep the two definitions straight.
 
Chemo infusion definition: You may have noticed how the definitions are similar for "IV injections" and "infusions." They both administer fluids and medications to the patient intravenously, according to the HCPCS Coding Clinic, Fourth Quarter 2001. But that is more or less where the similarities end. Injections and infusions may be similar procedures, but they're not identical - and code confusion can lead to denials.
 
"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 at the office of Mariette Austin, PhD, MD, in Easton, Pa.

---

New HCPCS Code   G0359* (Initial infusion, up to 1 hour, chemo)

Existing CPT Code  96410 (... infusion technique, up to one hour)

---

New HCPCS Code  G0360 (Each additional hour) 

Existing CPT Code  +96412 (... infusion technique, one to 8 hours, each additional hour [list separately in addition to code for primary procedure])

---

New HCPCS Code   G0361 (Initiation of prolonged chemotherapy infusion) 

Existing CPT Code  96414 (... infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump)

---

New HCPCS Code  G0362 (Additional sequential infusion, up to 1 hour, chemotherapy)

Existing CPT Code  +96412

---

New HCPCS Code G0363 (Irrigation of implanted venous access device)  

Existing CPT Code 99211 (Office or other outpatient evaluation and management of an established patient ...)