Oncology & Hematology Coding Alert

Also coming next year: A code for PICC blood draws

When a patient needs more than one IV push of the same drug, oncology and hematology coders have had a way to report the first push, but not the additional ones. But the -one code per drug- rule may be changing in 2008, with the addition of a new CPT add-on code.
 
The new CPT code, +90776 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of the same substance/drug provided in a facility [list separately in addition to code for primary procedure]), covers each additional sequential IV push of a therapeutic, prophylactic or diagnostic injection provided in a facility.

Not so fast: Exactly who this code is for and when coders should report it is unclear. Because physicians don't bill for administrations outside the office, this code may be pertinent only in a facility setting--that is, a hospital, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

Now, experts believe that only hospitals will be able to report 90776 and that it will be an add-on code that must be accompanied by 90774 (- intravenous push, single or initial substance/drug) or +90775 (- each additional sequential intravenous push of a new substance/drug [list separately in addition to code for primary procedure]), Parman says. -We won't know for certain until the AMA releases CPT Changes: An Insider's View 2008- in November, she says.

If those predictions prove true, hematologists and oncologists providing infusions in a nonfacility setting will still have to report only one unit of 90774, no matter how many subsequent IV pushes of the same drug the patient might receive during that day of service.

The existing code 90775 covers additional pushes of a new drug, as opposed to more pushes of the same drug, says Tricia Katzberg, RHIT, CPC, CCS-P, coder for the Bend Memorial Clinic in Bend, Ore.

Use 90769-90771 for Subcutaneous Infusion

If you-ve had trouble obtaining proper payment for subcutaneous infusion that's not for chemotherapy, three new codes in 2008 could make your life much easier.

New codes 90769-90771 cover subcutaneous infusion for -therapy or prophylaxis.- The codes cover subcutaneous infusion via pump up to one hour, each additional hour, and -each additional pump setup with establishment of new subcutaneous infusion site(s).-

There are now no codes for any type of subcutaneous infusion, regardless of whether it is chemotherapy or not, Parman says.

Pick 36592 for PICC Blood Draw

You will also see some oncology and hematology changes in the venous access codes. One long-awaited code makes its debut, while others rearrange themselves around it.

CPT 2008 will include 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified). This code should satisfy the need for a code to report drawing blood from a peripherally inserted central catheter (PICC). Such a code was proposed at the CPT Editorial Panel's meeting in 2006 but did not appear in the 2007 CPT manual.

Now, you should include the PICC blood draw as part of the evaluation and management service--but you can't use this service to raise your E/M levels.

Two other procedures have been given new CPT code numbers to fit the new numbering scheme, although the code definitions did not change. Current code 36540 (Collection of blood specimen from a completely implantable venous access device) will become 36591 in 2008, while 36550 (Declotting by thrombolytic agent of implanted vascular access device or catheter) will become 36593.

Welcome New Needle Placement Codes

More changes: Radiation oncologists will welcome three new codes for brachytherapy needle placement into muscle or soft tissue (20555), the head and neck region (41019), and the pelvic and genital region (55920).

Radiation oncology coders will also find some minor wording changes in some of the stereotactic radiosurgery (SRS) code descriptors. In 2008, the phrase -cerebral lesion(s)- will read -cranial lesion(s)- for codes 77371, 77372 and 77432.

And the descriptor for initial hydration infusion code 90760, which previously read -up to 1 hour,- now clarifies that the service must last -31 minutes to 1 hour.- Hydration lasting between one and 30 minutes will probably not be separately reportable, experts predict.