Billing 96523 with G0498

lynbanks

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Does anyone have reference to specific guidelines related to being able to bill CPT code 96523 (Irrigation of implanted venous access device for drug delivery systems) with HCPCS code G0498 (Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/other outpatient setting using office/other outpatient setting pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/other outpatient setting, includes follow up office/other outpatient visit at the conclusion of the infusion)
 

CodingKing

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This recently came up at work. Answer straight from the CPT book:

"Do not report 96523 in conjunction with other services"
 

CodingKing

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I already responded via PM as well but in case anyone else find this thread
NCCI manual CHAPTER XI

Section B.9 (Therapeutic or Diagnostic Infusions/Injections and Immunizations)
&
Section N.4 (Chemotherapy Administration)

Flushing or irrigation of an implanted vascular access port or device of a drug delivery system prior to or subsequent to the administration of chemotherapeutic or non-chemotherapeutic drugs is integral to the drug administration service and is not separately reportable. Do not report CPT code 96523
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2016 NCCI Manual - https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/2016-NCCI-Policy-Manual.zip

2017 NCCI Manual - https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/2017-NCCI-Policy-Manual.zip
 

fami

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g0498

Billing clarification on G0498 code:

The effective date is retroactive to January 1, 2016, but the implementation date is October 3, 2016. Thus, Medicare cannot accept claims with this code prior to October 3. The temporary code that can be used until G0498 is accepted from the local A/B MAC is 96549 (unlisted chemotherapy procedure). If this code is billed (by physicians or clinics), they will need to add a narrative in item 19 of the CMS-1500 or electronic equivalent that states, “96416 plus pump.” This will ensure reimbursement at the rate equal to 96416 plus an additional amount for pump rental. The drugs are always separately billable.
 
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