Oncology & Hematology Coding Alert

Question: We have patients who come into our office to pick up a few weeks worth of supplies at a time. These include empty syringes, needles, dressing and Heparin. I was told supplies are inclusive of an office visit, but because there is no visit what is the best way to bill?

Arizona Subscriber

Answer: Medicare does not reimburse for the supplies listed because it includes them in patient care. Medicare will pay for supplies such as syringes and needles (A4206-A4209) when they are related to certain procedures like bone marrow biopsies (85102), but in the case you describe this does not apply. Heparin (J1642) is a drug and is still paid by some Medicare carriers. However, because the patient is taking it home, it is not reimbursable. If the patients insurance is a non-Medicare insurance plan, it is possible to bill for some of these supplies. You should check with your commercial payers to determine what will be covered.

If the quantity represents a lot of money, it would be wise to call the carrier to preauthorize the supplies. You should be prepared to explain why you want to send these home with the patient for example, convenience or lack of pharmacy benefit where patient would have to pay out of pocket.

Finally, there is no office visit to code because one did not occur.