Oncology & Hematology Coding Alert

Question: How do you get paid for accessing a port for a subclavian catheter? Some carriers are denying payment.

Anonymous Pennsylvania Subsciber

Answer: According to Elaine Towle, CMPE, New Hampshire Hematology/Oncology, accessing a port is not a separately payable service under the Medicare program. Medicare considers this procedure part of the primary service. Other payers, however, may make a separate payment, usually under code 96530. However, you can bill for flushing the port if it is NOT done on the same day as chemotherapy.

For Medicare, if a patient comes to the office for port maintenance and does not see a physician, Medicare will pay for a Level 1 visit (99211). If the patient does see the physician, port maintenance is considered part of the E/M service (99212-99215). Some Medicare carriers will pay for the heparin (J1642) and saline (J7050-J7051) used in the procedure.

Other payers that pay for port maintenance usually do so under code 96530. Drugs and saline used can be billed under their J-codes. Jere Roswech of Carolina Cancer Center advises against billing J7051 on Medicaid claims because it will end up in edit and delay payment 90 days to 6 months.

However, payment policies for state Medicaid programs vary from state to state. She also suggests that including the cancer diagnosis codes helps ensure reimbursement.