Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 24, 2007 PDF

Caution: Don't bill regular ventilator management codes for nursing home patients next year

Struggling with complex drug injections or ventilator management? January's CPT update could come to your rescue! Here's a lowdown on some changes that could be coming down the pike.

- Chemotherapy codes may become easier to use in 2008, says one source familiar with the CPT panel's decisions. Currently, you mainly use chemotherapy codes with antineoplastic agents. But in 2008, you could be able to use these codes with other agents that have a similar amount of complexity or effort as the antineoplastics.

-Some of the agents that might have fallen under simple drug infusion might go up to another code- next year, the source tells The Insider. That way, you can bill for them using chemo intravenous infusion or IV push codes.

For example: Doctors inject Omalizumab, which sells under the brand name Xolair, to treat asthma. Because this drug requires a lot of work in the office, including reconstitution and monitoring, some doctors want to be able to use a code such as chemotherapy code 96401 for it, instead of subcutaneous injection code 90772.

The new wording in CPT 2008 may -open the door for a drug like that- to use a code such as 96401, says the source. But he cautions that the final wording in the CPT book may be more restrictive.

- Ventilator management may be breaking up into three new codes, says the source. Some members of the CPT panel were concerned that the current ventilator management codes (94656-94657 and 94660-94662) don't distinguish between acute and long-term patients.

If a patient is in a long-term care facility for months on a ventilator, then the doctor is -just going through and eyeballing the patient.- This isn't the same as managing an acute patient on day three or four of a ventilator. So the ventilator management codes will split into acute care and nursing facility codes. You-ll still have codes for the first day and each subsequent day, the source says.

- Coders were excited when CPT 2007 included two codes for Coumadin management (99363-99364). But then Medicare put them on the Status -B- (for bundled) list. CPT 2008 may be including changes to the Coumadin codes that could make them more acceptable to Medicare, the source says.

Caution: None of these changes are official until the CPT book comes out in November.