You Be the Coder: Multi-Use Vials (November 2001)
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We purchase Ativan (J2060) in 20-mg multi-use vials. The billing unit is 2 mg, which means 10 people should be billable from this vial. Our doctors contend the standard dose of Ativan is 0.5 mg, which means we can get 40 doses out of the vial. Should we bill one unit and waste 1.5 mg [...]
How Do You Choose? Modifier -21 Versus Prolonged Service Codes (November 2001)
Oncologists routinely spend extra time with patients and their families explaining diseases and treatment. But oncology practices often code for these services incorrectly, or payers present barriers that inhibit billing for the added time spent with patients. To get paid for what you deserve, you should either use prolonged service codes (99354-99355) or use time as a factor when determining the level of an E/M visit with a Medicare or privately insured patient. Modifier -21 (prolonged [...]
News Brief: Oncology Diagnosis Codes Unchanged in 2002 (November 2001)
The ICD-9 2002 includes no major changes for oncology practices. “The largest section of oncology-related diagnosis codes neoplasms remained unchanged,” says Nancy Giacomozzi, office manager for P.K. Administrative Services in Englewood, Colo. The American Society of Clinical Oncology’s policy and professional practice department encourages physicians and coders to continue the annual ritual of comparing their chargemasters to the newest version of the ICD-9 to ensure minute changes are updated.
Reader Questions: Neupogen and Leukine on the Same Day (November 2001)
Question: A Medicare patient was referred to us for an injection of Neupogen (J1441) and Leukine (J2820) on the same day, with a diagnosis of neutropenia. Can we get paid for both drugs?Florida Subscriber
Answer: You may bill separately for the same-day usage of Neupogen and Leukine because Medicare guidelines do not specifically prohibit two drugs to be injected on the same day. Absent any specific Medicare guidelines that prohibit or condone such a billing practice, [...]
Reader Questions: Stem Cell Transplants (November 2001)
Question: How should I code stem cell transplants involving donor leukocyte infusion (DLI)? Would these be coded as 90780 and 90781, or 36430?Michigan Subscriber
Answer: Stem cell transplantation (38240-38241) is a process where stem cells are harvested from the patient or a donor for intravenous infusion. These cells may be obtained from bone marrow or peripheral blood. The stem cell transplant can be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy and/or radiotherapy [...]
News Brief: Oncology Codes Unaffected by CCI Edits (November 2001)
The latest edits to Medicare’s Correct Coding Initiative (CCI) will have little effect on oncology and radiation oncology practices, according to the American Society of Clinical Oncology’s public policy and practice department. Carriers rely on the changes to determine whether certain codes should be paid separately or bundled. This remains unchanged in the three major categories most relevant to oncology chemotherapy administration, bone marrow biopsies, and radiation oncology. For example, chemotherapy administration codes such as 96410 [...]
New Source of Revenue for Potentially Life-Threatening Cases (October 2001)
As late as 1999, cancer patients admitted to an inpatient facility had to be unstable or at high risk of dying before his or her oncologist could report 99291 (critical care, evaluation and management). Changes in the definitions of critical care services allow oncologists now to bill for the complex care and medical decision-making that are needed in caring for patients whose disease or treatment has impaired vital organ systems and may be life-threatening. In the [...]
Bulletproof Pain Management Claims: Follow AHRQ Guidelines (October 2001)
Pain management payment policies can be vague, and claims may lead to denials despite an oncology practice’s efforts to follow a Medicare carrier’s medical review policy. If, however, practices follow cancer pain guidelines from the Agency for Healthcare Research and Quality (AHRQ) (formerly the Agency for Health Care Policy and Research, AHCPR), they can make their pain management claims bulletproof. This is achieved by using standards that not only mirror Medicare policy but also provide [...]
You Be the Coder: Billing for Supplies (October 2001)
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our physicians want to bill for a new bone-marrow tray. But we are a clinic, and the physician performs biopsies in our local hospital. The hospital does not use this supply. Can we order these trays, take them to the hospital, and then bill for them from our facility?Arizona Subscriber
Answer: Although you must pay for [...]
