Oncology & Hematology Coding Alert

Why you should never use 96530 for flushes

To get the full benefit of Medicare's recent increases in drug administration pay, make sure you're properly coding pump refills and infusion services. Follow these three field-tested tips to ensure you get what you deserve with pump refill and non-chemotherapy infusion codes. 1. Use Code 96530 for Refills and Maintenance Often, oncology coders become confused about when to report 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]), because they want to use the code for flushes and blood draw services, coding experts say.

Strategy: Use this code when the oncologist refills or performs maintenance on a chemotherapy pump or reservoir, says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Powder Springs, Ga.

In 2004, code 96530 pays $152, which is a $110 increase from 2003 rates. To get paid for 96530, Parman recommends that the physician's refill documentation support the following:

 the implantable pump's status before and after refill
 the patient's response to current medication dose and rate
 reasons for any change in dose or type of medication
 any necessary reassessment of the patient's overall condition or physician's treatment goals. 2. Bill 99211 for Flushes If you're assigning 96530 for the oncologist's port flushings or blood draws, you could be losing out on reimbursement and violate Medicare requirements for port flushes, Parman says.

When the patient makes a special visit to the oncologist for a port flushing, you should report 99211 (Office or other outpatient visit for the E/M of an established patient ...), according to the Medicare Carriers Manual (MCM), section 15400 (E). Most physicians don't perform routine port maintenance. Instead, they supervise the service.

Don't miss: And, if your oncologist provides vascular access port flushing prior to a chemotherapy treatment, Medicare will consider the flushing to be an integral part of the chemotherapy administration, Parman says. For example, you could not report a separate procedure code (e.g., 99211) along with 96408, (Chemotherapy administration, intravenous; push technique) if the physician flushed the ports before administering chemo. Watch Out for Blood Draws If you list 96530 for blood-draw services, you are coding inappropriately, Parman says.

Code 96530 represents the refilling or maintenance of a pump or reservoir. Therefore, using the code to report a blood draw would violate CPT requirements, which state, "Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code."

Typically, you should use the appropriate venipuncture code (36400-36425) to report a blood draw. 3. You Can't Bill [...]