Oncology & Hematology Coding Alert

Question: Medicare has been denying our therapeutic push claims (90784). We use the drug Decadron during a chemotherapy session. Previously, we billed chemotherapy pushes (96408) for the Decadron, but I thought this was incorrect since it is not an anti-neoplastic drug. We can we do?

Georgia Subscriber Answer: Although Decadron is not a chemotherapeutic agent, many practices use the drug in cancer care to manage side effects and to treat the cancer itself. When the physician or nurse provides a Decadron injection, you may report 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous); however, insurers won't pay for the injection if your oncologist or nurse is also administering chemotherapy.

If the physician or nurse provides Decadron prior to or subsequent to the chemotherapy administration on the same day, you may use 90784-59 (... injection; distinct procedural service). Another thing to remember is that you can't report 90784 and 99211 (Office or other outpatient visit ...), according to Medicare guidelines.