Oncology & Hematology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.   Question: How should I bill for chemotherapy pump refills in the outpatient hospital setting? Should I report code 99211 for the nursing time (which is minimal) and the J codes for the drugs?
  Maryland Subscriber
  Answer: If the physician refills the pump in the outpatient hospital setting, report 96520 (refilling and maintenance of portable pump) or 96530 (refilling and maintenance of implantable pump or reservoir). If the physician documents an E/M service, it is possible to bill 99211-99215 (office or other outpatient visit).
If the hospital nurse refills the pump, there is no professional charge. Outpatient hospital services are not considered "incident to" physician services, meaning you cannot bill 99211 for outpatient services. To bill this code requires that the nurse be an employee of the physician, that the physician be in the office suite during the visit, that a physician prescribe the service, and that the nurse or other employee document the service provided.   Also, the hospital would bill the drugs and receive ambulatory payment classification (APC) reimbursement from Medicare or contracted reimbursement from other payers. It would happen rarely, but the only time physicians could possibly bill J codes for the drugs is if they bought the chemotherapeutic agents and supplied them to the hospital.