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Chemotherapy Infusions in the Office Setting

  1. #1
    Default Chemotherapy Infusions in the Office Setting
    Medical Coding Books
    Does anyone have some good resources for coding chemotherapy, diagnostic infusions in an office setting? I code for an Infusion Clinic which is office-based, not facility-based (hospital). Many, including insurances seem to be confused and give advice on coding in the facility setting. I do understand that coding for office-based is different.
    Thank you.
    Annette, CPC, CEMC

  2. #2
    I code for a Hematology/Oncology group. We do infusions and injections, both chemotherapy and therapeutic (no diagnostic infusions) in addition to some other ancillary procedures and several categories of E/M in office.

    What specific issues are you looking for information on?

    Alanna, CPC, CHONC

  3. #3
    There seems to be no rhyme or reason for denials from commercial insurances. Some pay for hydration, while other will not. Some will pay for subq injection with a -59 modifier with infusion codes (the subq is for a totally different diagnosis than the infusion), and some will not, even with the -59 modifier. I have checked NCCI edits for all code combinations, but still some insurances will not pay while others will. Even Medicare gets confusing too. I am trying to correctly code these services, but having challenges. Should I code by insurance company, or should I code correctly, the CPT/NCCI way?

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