Wiki Hematology/Oncology Coding - Where I work has just acquired

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Sandra Roberts

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Where I work has just acquired a Hematology/Oncology office, and I have questions for anyone that is coding for this type of office. We are owned by a Hospital and we have a department that does the physician portion of the billing. On 96367 we have applied a modifier 59 and now we have been told to remove all of them is this correct? If a patient has labs, blood draw from port, and heparin flush can they be billed for the 96523? These questions have arose from the billing office on the physican side, the hospital is saying no, but the coder for the office is saying yes. Thanks for your time.
 
I'm not sure where you're located but I pulled the following information from the Trailblazer site about the 96523...Hope this helps.. I found this on page 5 of the link below.

Medicare will consider payment for code 96523©, irrigation of implanted venous access device for drug delivery systems, if it is the only service provided that day. If there is a visit or other chemotherapy administration or non-chemotherapy injection or infusion service provided on the same day, payment for 96523 is included in the payment for the other service.

http://www.trailblazerhealth.com/Publications/Job Aid/ChemotherapyAdministrationPartB.pdf
 
96523

That's correct. To ensure we dont' make the mistake, we have that noted on our charge ticket that 96523 is either charged by itself or that it cannot be charged with any other service.
 
I code for 4 oncology clinics in the state of Colorado. I would be happy to help you with any coding needs. Please email me privately if you have further questions.

It is correct to bill only the 96523 it can be the only CPT code billed for that DOS.
We do not bill for blood draws on the same day or when any infusion are done as it is bundled into the infusion codes. You have to do routine blood draws to see if the patient can take infusion for that day.
 
Last edited:
sandrar said:
Where I work has just acquired a Hematology/Oncology office, and I have questions for anyone that is coding for this type of office. We are owned by a Hospital and we have a department that does the physician portion of the billing. On 96367 we have applied a modifier 59 and now we have been told to remove all of them is this correct? If a patient has labs, blood draw from port, and heparin flush can they be billed for the 96523? These questions have arose from the billing office on the physican side, the hospital is saying no, but the coder for the office is saying yes. Thanks for your time.
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If you are owned by the facility, then your provider does not pay rent for his office, is this correct? Which means your POS is a 22 and not an 11, is this how you are doing it? If so then the IV administration codes, hep flush, etc. can be billed only on the facility side as they are ordered by the physician but administered by the nurse who is a facility employee. If I have the circumstances of your relationship incorrect, please let me know.
 
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