Oncology & Hematology Coding Alert

Get what you deserve with 90780-90788 Medicare didn't target only chemotherapy codes for payment increases, but pumped up reimbursement for therapeutic infusions and injection codes (90780-90788), as well.
 
When the oncologist uses drugs to treat a patient's side effects to chemotherapy, oncology coders often report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour).
 
The national average for 90780's payment rate is $118, and the code carries 2.30 RVUs. In 2003, you could have expected $43 for the code, which had 1.16 RVUs. Oncology practices usually bill 90780 for the oncologist's hydration therapy before and after chemotherapy administration, says Lisa C. Wood, office manager at the Cancer Center of the Piedmont in Danville, Va. When reporting hydration during chemotherapy, make sure to attach modifier -59 (Distinct procedural service) to 90780, she says.
 
By using the modifier, the insurer will know that the physician performed hydration as a service separate from the chemotherapy administration. Make sure you don't report 90780 for hydration therapy administered at the same time as chemotherapy, because Medicare includes payment in the chemotherapy codes.
 
For example, if a patient suffers from nausea and vomiting (787.01), your physician may administer antiemetics to treat the condition. In that case, you would list 90780-59. If the infusion lasts longer than one hour, but no longer than eight, you may report +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]). The add-on code pays only $33, about $12 more than the code did last year.
 
Although increases in administration payments won't completely recover lower drug revenue, improved reimbursement for codes 90780 and 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour) may prove to be a "significant benefit" for oncology practices, Wood says. Based on national averages, Medicare increased 96410's payment from $59 to $217. Use 90782 for Epoetin Injections Oncology coders report physician injections using 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular). Typically, you could assign 90782 when an oncologist injects epoetin alpha (Q0136, Injection, epoetin alpha [for non ESRD use], per 1,000 units) into a chemotherapy patient with anemia (285.22, Anemia in neoplastic disease).

When you submit 90782 in 2004, Medicare will pay about $25, a 458 percent jump from $4 in 2003.
 
If you bill other therapeutic infusion or injection codes, you may see the following payment increases:
   90783 (... intra-arterial) pays $25, up from $16.
   90784 (... intravenous) pays $50, an increase of more than $30.
   90788 (Intramuscular injection of antibiotic [specify]) pays $22, rather than $5.
 
Note: The above drug-payment rates were based on national averages supplied by the American Society of Clinical Oncology in Alexandria, Va. The rates [...]