Oncology & Hematology Coding Alert

Question: We recently performed a port flush on a patient with an implanted pump. We reported 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]) and the carrier denied the claim. This was a scheduled appointment specifically for the flushing. Is there a better code to report?


Montana Subscriber

  
Answer: Yes, there is a better code for port flushings. Oncology coders sometimes report 96530 for flushes, which is incorrect.
 
On a Medicare claim, you should report G0363 (Irrigation of implanted venous access device) for the flush in 2005.

On a private-carrier claim, you should report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services.) for the flush.

Why? Medicare considers this a low-level service because oncologists typically supervise routine port maintenance but do not provide the service.

Heads-up: When the physician or nurse flushes ports pre-chemo, the rules change. If your physician flush ports just before chemotherapy, the flush is bundled into the chemotherapy administration code and 99211 is not reportable. Also, you should report 96530 only when the oncologist either refills or performs maintenance on a chemo pump/reservoir.