Oncology & Hematology Coding Alert

Stop pouring the dollars down the drain. Many of your chemotherapy patients need hydration services, and you should get paid for them.

Documenting separate services is also crucial if the physician is billing for hydration in addition to chemotherapy. For example, when a patient presents for a scheduled chemotherapy treatment and following the chemotherapy becomes dehydrated, the physician treats the patient with a saline-solution infusion.

In this case, you should separately report the chemotherapy, the infusion, and the E/M service. The physician is giving the saline solution as a hydration treatment, not as a vehicle to deliver a different drug, such as one for chemotherapy, says Jeanne Smith, reimbursement specialist for Madrona Medical Group, a large multispecialty group in Bellingham, Wash.

For the chemotherapy treatment, report the appropriate chemotherapy administration code (96400-96549), such as 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour). For the infusion administration for hydration, use the infusion codes (90780-90781).

"Clearly document that the chemotherapy and the hydration therapy were administered sequentially or as separate procedures," Smith says.

For the physician's patient evaluation, which led to the infusion, assign an office visit code (99211-99215). Remember to append the office visit code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). The guidelines for chemotherapy administration state, "If a significant, separately identifiable Evaluation and Management service is performed, the appropriate E/M service code should be reported in addition to 96400-96549." Your physician's decision to hydrate the patient required a separate E/M service to treat the emergent complication. The final report of the example should read 9921x-25, 96410 and 90780. Charge for the Drugs,Not the Supplies The infusion codes include the supplies but not the infused substance. "The supplies, such as needles and tubing, are bundled into the infusion administration codes," Smith says. Bill the infused drugs separately with the appropriate HCPCS level II J codes. Using the example above, you should report any infused agents, such as J9370 (Vincristine sulfate, 1 mg) for the chemotherapy drug and J7042 (5% dextrose/normal saline [500 ml = 1 unit]) or J7120 (Ringer's lactate infusion, up to 1,000 cc) for the saline solution. Do Not Assign Prolonged Services Do not report prolonged services (99354-99357) in addition to the infusion codes (90780-90781) because prolonged services codes are time-based and added to E/M services. Prolonged services and infusion codes also have different requirements for physician supervision. Under the infusion requirements, the physician must supervise the patient's case but does not have to remain physically present throughout the infusion. Although the infusion codes require the physician's presence in the office, the physician does not have to be in the [...]