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])

 
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