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Thread: new to chemo

  1. #11
    Join Date
    Apr 2007
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    Columbia, MO
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    Promo: Code Books
    I do not think it is a difference in Payer interpretation, The AMA is pretty clear in how this is to be done they use to (and may still) have a very good complete instruction on how to code infusions on the AMA website. It is not abiguous at all.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12
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    Apr 2007
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    Nashville AAPC Chapter
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    I am going to add my experience here so that anyone reading this thread will have additional information to learn from. I am agreeing with Helen based on my experience from reading audit reports on our Oncology clinic.

    We have been told to view infusion time just like a time line and if there is overlap with infusions (pushes or infusions) then you cannot bill for both. They are considered bundled. We cannot double dip the time for the work by infusion. There must be administration into two different holes into the patient to be able to bill separately.

    The compazine push time runs concurrently with the chemo and it cannot be billed. This is not an infusion by definition so a 96368 is not appropriate. It is by definition a push as it runs less than 15 minutes.

    The only drug that comes to mind that you can bill as concurrent is Leucovorin. Because it is usually into a separate line from the chemo drug.

    In addition:
    We also recieved several denials from insurance companies after submitting our records and they stated that the push within the start/stop time of the infusion into the same line/hole for the patient is not allowed. This would be the same if two drugs were given as an infusion. Only code for one infusion.

    I hope this helps a little more.

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