Oncology & Hematology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I bill for accessing the port for the infusion technique for chemotherapy? Should I bill 61070 with 96408 and 06410, or does the 96410 imply the accessing of the port? Is there another way to bill this?

California Subscriber
            Answer:  Medicare considers "accessing the port" part of the infusion service. Section 15400 of the Medicare Carriers Manual says, "Flushing of a vascular access port prior to administration of chemotherapy is integral to the chemotherapy administration and is not separately billable." Many payers follow Medicare's guidelines however, there may be carriers that will reimburse.
 
One code that may be payable is 36000 (introduction of needle or intracatheter, vein) Ask individual payers if they will recognize it.
 
Code 61070 (puncture of shunt tubing or reservoir for aspiration or injection procedure) is specific to the nervous system and is not appropriate for use with chemotherapy administration. For central nervous system (CNS) chemotherapy administration, use 96450 (chemotherapy administration, into CNS [e.g., intra-thecal], requiring and including lumbar puncture).  Another code for chemotherapy administered into an Omaya reservoir is 96542 (chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents).