AHRQ Guidelines   (October 2001)

The Agency for Healthcare Research and Quality (AHRQ) recommends physicians follow these guidelines when determining the type and scope of pain therapy:  
An essential principle in using medications to manage cancer pain is to individualize the regimen to the patient.
The simplest dosage schedules and least invasive pain management modalities should be used first.
Pharmacological management of mild to moderate cancer pain should include a nonsteroidal anti-inflammatory drug (NSAID) or acetaminophen, unless there is a contraindication.
When [...]

Bill 90780 and 90782 Separately From Chemotherapy   (October 2001)

Claims that report the administration of support-care drugs – whether the drugs are given by infusion or injection – should be coded separately from chemotherapy administration when the two procedures are done sequentially of chemotherapy. Some oncology practices may be unnecessarily bundling nonchemotherapy infusions and injections, believing that Medicare considers the services part of same-day chemotherapy administration, says Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans. Code 90780 (therapeutic or diagnostic infusion, [...]

Reader Question: Two Physicians   (October 2001)

Question: Under what circumstances can two  physicians in the same practice bill for an inpatient visit on the same day? Maryland Subscriber  Answer: Reimbursement is made once per day on a subsequent hospital visit per practice. A patient is considered part of the same practice and specialty. The exception is if the second doctor was required to see the patient due to a complication, worsening condition or new problem. In this case, bill the appropriate E/M [...]

Reader Question: Blood Draw Center   (October 2001)

Question: We are a new outpatient cancer center and just started to draw blood. We are attached to a hospital that has a lab. We draw blood and then send it to the lab to be processed. Expenses are incurred for the supplies. Can we charge for the blood draw?           Colorado Subscriber       Answer: How a practice codes for routine blood draws depends largely on whether it has its own laboratory or sends samples to an outside [...]

Reader Question: Prolonged Service   (October 2001)

Question: An oncologist in our practice admitted a patient for observation. He was told that he could not bill Medicare for any E/M services. Can he bill for prolonged service time?             Louisiana Subscriber
 Answer: On occasion, an oncologist may be required to admit a patient to a hospital observation unit. Perhaps a patient had an adverse reaction to chemotherapy or supportive-care drugs, which require hospital attention, but is not serious enough to warrant inpatient admission. [...]

New Codes for Expanded PET Scan Coverage Allow for Added Reimbursement   (September 2001)

Medicare has issued 21 temporary codes (effective July 1, 2001) for reporting positron emission tomography (PET) scan procedures used to diagnose, stage and restage esophageal, head and neck, lung and colorectal cancers, lymphoma and melanoma. The new G codes replace G0126 (PET lung imaging of solitary pulmonary nodules, using -2-[fluorine-18]-flouro-2-deoxy-d-glucose [FDG] following CT [71250/71260 or 71270]), G0163 (positron emission tomography [PET], whole body, for recurrence of colorectal metastatic cancer), G0164 (positron emission tomography [PET], whole [...]

Get Paid for Case Management With G0181 and G0182   (September 2001)

When a patient is referred to a home-health agency or hospice, the oncologist is not excluded from having a say in treatment, and all billing opportunities are not lost. A physician whose patient is being cared for in a home-health or hospice setting can code several services related to case management, including G0181 and G0182 for care plan oversight (CPO). (See definitions below.) Oncology physicians often monitor their patients’ progress after a referral to a home-health [...]

You Be the Coder: Billing for Interleukin   (September 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 Interleukin, J9015? I believe the billing unit is the whole vial (18 million units). If a patient receives 4 million units three times a week, and the package insert indicates that it is only stable for 24 hours, should I bill the entire vial three times per week?Minnesota Subscriber
 

Answer: The [...]

Same-Group Consults Require Detailed Documentation   (September 2001)

Billing for a consultation (99241-99245) requested by a physician in the same group may raise the eyebrows of of Medicare carriers and may even cause a denial. But if the consult meets Medicare’s requirements, there is no reason why the practice shouldn’t be paid. “It can be hard if two physicians are in the same group,” says Nancy Giacomozzi, office manager for P.K. Administrative Services in Lakewood, Colo., which serves oncology practices. “What the payer sees [...]

Reader Question: Non-Chemotherapy Injections   (September 2001)

Question: I am having trouble getting reimbursed for 90784. Medicare states that it is not paid separately. How do we get paid for this procedure? Should we use modifier -59?Alabama Subscriber
 Answer: Codes 90782-90788 (therapeutic, prophylactic or diagnostic injections) are used when a drug such as epoetin alpha, Q0136, is used to combat anemia caused by chemotherapy. These drugs can be administered either at the same time as chemotherapy or separately from chemotherapy.  Coding for epoetin [...]