Results 1 to 8 of 8

Chemotherapy services

  1. #1
    Location
    Kansas City, MO
    Posts
    431
    Default Chemotherapy services
    Medical Coding Books
    I'm trying to learn billing for Chemo, and other injection/infusion services.

    From what I understand, hydration, when administered with the chemo, is not seperately payable. However you can bill it if it is administered seperately, as a subsequent service...for example if the patient becomes dehydrated because of the chemo.

    Is this correct?

    Does anyone have any resources on this?

    This is for an outpatient setting.

    Thanks.

  2. #2
    Default
    look at the NCCI edits (medicare/medicaid)
    otherwise read the CPT guidelines
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  3. #3
    Default
    I am a hem/onc coder and I code the Chemo and IV drug infusion for our group. Yes, Hydration when administered concurrently (with) chemo or an IV drug can not be seperately billed. Per CPT coding guidelines, Hydration, when administered at the same encounter as chemotherapy or other IV drugs must run 31 minutes or more independently of the IV infusion to be eligible for seperate billing, and would be reported using add on code 96361 (your initial service code would be your chemotherapy administration or other IV drug infusion administration).

    Hydration service code 96360 (intravenous infusion, hydration ;intial, 31 min to 1 hour) is an INITIAL service code and Can only be billed if it is just that the initial service, and the hydration is running at least 31 minutes up to one hour, each additional hour would be reported w/ 96361.

    The guidelines for reporting these services are in your CPT code book
    also you can find information on your local Medicare web site, and CMS Claims processing manual chapter 12

    Best Wishes!

  4. Default chemotherapy
    Some chemotherapy infusions require hydration pre and post chemo administration and CPT addresses this. You can code for the pre and post but any hydration given during the course of the administration of the chemo is not codable. Check your carrier and Medicare guidelines.

  5. Default
    Hello my name is Liza and I as well bill for chemo infusions. MrsClark75 is exactly correct. Medicare may allow you to bill for the actual solution and will reimburse for that you just cannot bill for the administration of it when it is administer concurrently with the chemo. As MrsClark stated it has to run for 31 mins or more and to my understanding it has to be done an hour before or after chemo.

    Thanks much,
    Liza

  6. Default
    Quote Originally Posted by LINDALOUH View Post
    I'm trying to learn billing for Chemo, and other injection/infusion services.

    From what I understand, hydration, when administered with the chemo, is not seperately payable. However you can bill it if it is administered seperately, as a subsequent service...for example if the patient becomes dehydrated because of the chemo.

    Is this correct?

    Does anyone have any resources on this?

    This is for an outpatient setting.

    Thanks.
    You are correct. You can bill for they hydration even during the pre meds but once the chemo starts, the hydration time stops. If the patient continues the hydration after the chemo, you can start billing this time as well. Hope this helps.

  7. #7
    Location
    Kansas City, MO
    Posts
    431
    Default
    Quote Originally Posted by mrsclark75 View Post
    I am a hem/onc coder and I code the Chemo and IV drug infusion for our group. Yes, Hydration when administered concurrently (with) chemo or an IV drug can not be seperately billed. Per CPT coding guidelines, Hydration, when administered at the same encounter as chemotherapy or other IV drugs must run 31 minutes or more independently of the IV infusion to be eligible for seperate billing, and would be reported using add on code 96361 (your initial service code would be your chemotherapy administration or other IV drug infusion administration).

    Hydration service code 96360 (intravenous infusion, hydration ;intial, 31 min to 1 hour) is an INITIAL service code and Can only be billed if it is just that the initial service, and the hydration is running at least 31 minutes up to one hour, each additional hour would be reported w/ 96361.

    The guidelines for reporting these services are in your CPT code book
    also you can find information on your local Medicare web site, and CMS Claims processing manual chapter 12

    Best Wishes!
    Thanks for responding. You said to use the add on code 96361, but in the CPT book under this code, it says "Code first (96360)", but I see it also says 96361 "INCLUDES hydration provided as a secondary or subsequent service after a different initial service..." These seem to contradict each other. Do these claims get paid without any problems?

  8. #8
    Location
    Kansas City, MO
    Posts
    431
    Default
    Oops, just read the answer in the the CMS manual...it clarifies that you CAN bill the add on with "another initial" service.

    Thanks to everyone for their help.

Similar Threads

  1. Chemotherapy - Can anyone confirm
    By crystalW712 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 05-06-2013, 10:07 AM
  2. Replies: 1
    Last Post: 12-05-2011, 08:10 AM
  3. 99051 Services provided in addition to basic services
    By vstoots in forum Billing/Reimbursement
    Replies: 2
    Last Post: 10-05-2010, 09:00 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.