Oncology & Hematology Coding Alert

Question: We received a denial for G9022 when we coded it with G0359, J9355, J1200, G9021, and G9029. The denial said PR-B6: The service is denied/reduced when performed/billed by this type of provider, by this type of provider and this type of facility, or by provider of this specialty. Can you explain the denial?

Louisiana Subscriber
 
Answer: You were correct in reporting one code for fatigue, but the problem is that you reported two codes for nausea/vomiting, and didn't report a code for pain.
  G9021 - Chemotherapy assessment for nausea and/or vomiting, patient reported, performed at the time of chemotherapy administration; assessment Level 1: not at all (for use in a Medicare-approved demonstration project)
  G9022 - ...assessment Level 2: a little...
  G0359 - Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug
  G9029 - Chemotherapy assessment for lack of energy (fatigue), patient reported, performed at the time of chemotherapy administration, assessment Level 1: not at all (for use in a Medicare-approved demonstration project)
  J9355 - Trastuzumab, 10 mg
  J1200 - Injection, diphenhydramine HCl, up to 50 mg. Codes G9021 and G9022 are both for nausea, depending on the level. You need to remove one of these codes and report a code for pain from G9025-G9028 (Chemotherapy assessment for pain, patient reported, performed at the time of chemotherapy administration...).