Oncology & Hematology Coding Alert

Question: Our hospital-based cancer program doesn't document the time for our chemotherapy infusions. A consultant recently pointed out that we could bill for pretreatment infusions such as antiemetics if we documented time. It was suggested that we keep a flow sheet of pretreatment, treatment and post-treatment infusions. Should we bill for all of these? Now, we bill only for the treatment infusions with the applicable Q codes. New Jersey Subscriber Answer: As a hospital-based cancer center, you are correct in billing Medicare with the Q codes. An error in the 2002 HCPCS book listed all these codes as deleted. CMS released a statement recognizing this error and instructing coders to continue using the Q codes for chemotherapy and infusions. The codes you should be using are: Q0083 Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push) per visit
Q0084 Chemotherapy administration by infusion technique only, per visit
Q0085 Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit. Normal saline used to facilitate the administration of the chemotherapy is not separately billable nor are any other medications given simultaneously with the chemotherapy. Therefore, it is important to document the start and end times of the medications infused. Only administration times need to be listed for noninfusions because this administration is not over a period of time.

Hydration fluid, antiemetics or other IV medications that are infused sequentially with the chemotherapy are billable with Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit). The sequential administration must be documented in the medical record. Document the time started and time ended for the infusion and chemotherapy. The Q code is listed "per visit." If you administer multiple antiemetics IV infusions or other IV infusions, Q0081 can only be billed once with the appropriate codes for the medications or IV fluid given. An example for a documentation flow sheet is above: