Part B Insider (Multispecialty) Coding Alert
Are You Throwing Away Reimbursement For Infusion Add-On Codes?
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Understand the difference between chemotherapy and pain management Oncology practices and others who provide infusion may find themselves providing continuous infusion for both chemotherapy and pain management. And if they don't understand the crucial differences between these two modes of infusion, they could lose out on crucial reimbursement. According to experts, there are a few major differences between infusion for chemotherapy and pain management that affect how you bill for them:
For chemotherapy, you use a continuous infusion pump when it's the most appropriate method for the patient's diagnosis. Providers use continuous infusion for 5-fluorouracil, most commonly prescribed for gastrointestinal cancers or in combination with other chemotherapy drugs. The main question you'll answer with chemo infusion is: "Is that an appropriate therapy for the diagnosis?" says Hickey.
With pain management infusion pumps, the pump is usually implanted by a surgeon or anesthesiologist, who can bill implantation codes 62350-62362 to cover implantation (with or without laminectomy), removal and preparation of a programmable pump. An oncologist isn't likely to be billing these codes, notes Hickey.
With chemotherapy infusion, you can bill for the insertion, revision or removal of the pump (36260-36262) as long as the infusion lasts longer than eight hours. And you can also bill separately for 96414 (Infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump). And if you're providing other medications at the same time as you set up the pump, you can bill for the "push" technique (94608 or 94620). You can no longer bill a 99211 (level one evaluation and management service) on the same day as chemotherapy drugs.
But for compounded chemotherapy drugs, most carriers will let you bill using the appropriate J-codes for the compounded drugs along with modifier -KP (First drug of a multiple drug unit dose formulation). Carriers will pay you 95 percent of the average wholesale prices for each compounded drug, says Bukauskas-Vollmer.
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