Reader Question: Blood Draw   (January 2002)

Question: How should I code a blood draw from an implanted catheter or Hickman catheter that can only be done in a physician’s office?New Mexico Subscriber
Answer: In 2001, CPT introduced 36540 (collection of blood specimen from a partially or completely implantable venous access device) to describe drawing blood from a catheter. Although Medicare is not reimbursing for this new code, many private payers pay at a level comparable to 36415 (routine venipuncture or finger/heel/ear stick [...]

New IMRT Codes Top the List of 2002 CPT^® Changes for Oncology Practices   (December 2001)

Oncology-related changes in CPT 2002 include a number of new codes for radiation oncology and some minor revisions to existing codes. The additions and revisions generally serve to clarify definitions or to assign codes to procedures that were previously reported with temporary G codes.  What remains to be seen is how CMS and private payers will respond to the revisions and whether the changes will affect their fee schedules. Oncology practices should begin preparing now [...]

Bone Biopsy and Aspiration Codes Moved to Surgery Section   (December 2001)

Two of the more significant changes in CPT 2002 are the new codes for bone marrow biopsies and aspirations:  
38220 bone marrow aspiration 
38221 bone marrow biopsy, needle or trocar.
These codes replace bone marrow biopsy code 85102 and bone marrow aspiration code 85095. The change moves the bone marrow procedures out of the pathology and laboratory section of the CPT and into the surgery section of the manual. This revision identifies the removal of bone marrow [...]

Reader Question: Accessing a Port   (December 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I bill for accessing the port for the infusion technique for chemotherapy? Should I bill 61070 with 96408 and 06410, or does the 96410 imply the accessing of the port? Is there another way to bill this?California Subscriber

Answer:  Medicare considers “accessing the port” part of the infusion service. Section 15400 of the Medicare [...]

Observation Codes: Usage Depends on Discharge and Admission   (December 2001)

When billing for observation of a patient in a hospital (99218-99220), oncology practices must consider whether the patient was discharged or had a subsequent admission. And observation can occur in a hospital outpatient unit as well as in a hospital room normally used for inpatients, says Margie Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans. Oncology practices can still use observation codes if the patient is not in an “observation [...]

Reader Question: Medical Radiation   (December 2001)

Question: May we bill for the technical component with 77300-77334? If so, what documentation do we need?Colorado Subscriber
 Answer: A number of services are included in 77300-77334 (medical radiation physics, dosimetry, treatment devices, and special services), and all of them include a professional and technical component. Following is key information for documenting the facility component. Code 77300 (basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, as [...]

Reader Question: Blood Draws   (December 2001)

Question: Can a physician’s office bill for a blood draw if it is done by a nurse employed by a hospital and not by the physician who ordered the procedure?Maine Subscriber
Answer: No. A practice may only bill for work performed by employees of the office and for supplies that they have purchased.  A good rule of thumb is that if the service did not represent an expense to the practice, it should not be billed. [...]

Reader Question: Special Radiation Treatment Procedure   (December 2001)

Question: What documentation is needed to bill 77470?New Jersey Subscriber
 Answer: Documentation must include a diagnosis of a new neoplasm and a treatment plan for a distinctly separate course of radiation therapy supporting the medical necessity. Medicare is aware that 77470 (special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone irradiation]) may be misused. To assure carriers that you are using it correctly, physicians must document the extra time needed to [...]

Isodose Plans: How To Get Paid for More Than One   (November 2001)

It is common for radiation oncologists to design multiple isodose plans (77305-77315) to plot lines for more than one treatment field and/or for a single area of interest all in one day. Confused by Medicare regulations, some oncology practices bill for only one of the isodose plans done that day, although each of the plans will be used for separate rounds of radiation treatment. Medicare rules account for the fact that multiple plans developed on the [...]

Determine When To Bill Supplies Separately   (November 2001)

Reimbursement for chemotherapy administration is often barely enough to account for the supplies, nursing services and other related costs. Rather than writing off supplies as included in payment for chemotherapy services, oncology practices should consider whether they are missing allowable billing opportunities. Not all supplies are bundled with chemotherapy administration or an office visit. “Supplies are usually not payable,” says Elaine Towle, CMPE, practice administrator for New Hampshire Oncology and Hematology in Hooksett, N.H. “However, they [...]