Reader Question: Administering Epoetin-alfa   (January 2000)

Question: One of our readers challenged us to review our December advice again on the proper methods for coding the administration of epoetin-alfa (Q0136), stating that Procrit and Epogen are shots, and to use the chemotherapy infusion codes is incorrect. So, we checked with more of our experts, and asked: What is the proper way to bill for epoetin-alfa if the drug is administered after chemotherapy has been completed? Answer: Epoetin-alfa, a biologically engineered protein [...]

Oncology Coding Changes in CPT 2000   (December 1999)

Coding changes for radiation oncology top the list of new codes and revisions included in the recently released CPT 2000. The change represents a theme to reduce the amount of subjective choices coders must make and allow them to assign a code based on more specific criteria, experts say. CPT 2000 is very specific and easier to use, says Dianne Willard, RHIA, CCS-P, director of coding products and services for the American Health Information Management [...]

Avoid Loss in Bundled Payment By Billing Some Services Separately   (December 1999)

Its not uncommon for an oncology practice to accept bundled payment for chemotherapy services. This includes the costs of the chemotherapy drug, its administration, and intravenous solutions, tubing, start kits and a host of other services the payer wants to include. Physicians accept this bundled arrangement out of fear of being cut off from patients and/or in exchange for being paid faster by the HMO. The hope is that they can provide a high level of [...]

Correctly Code Epoetin-Alpha (EPO [Epogen, Procrit]-Q0136) to Gain Prompt Payment   (December 1999)

Putting the right codes in the right order helps get claims paid promptly. Any claims that include epoetin-alpha, Q0136, (EPO [Epogen, Procrit]), a biological response modifier, require a different order than claims for chemotherapy claims. Epogen and Procrit (epoetin-alpha, Q0136) are adjuncts to chemotherapy, used to treat chemotherapy-related anemia. The most important thing is to match the right ICD-9 with the appropriate CPT-4 or HCPCS codes. Although Medicare guidelines require that claims be transmitted electronically, [...]

Payment for Cancer Treatment Depends on Documentation   (December 1999)

Insurers often fail to acknowledge the unique complexity of cancer treatment and the level of E/M services needed. This often leads to the carriers downcoding the claims. Then, frustration with downcoding and concern about audit or fraud allegations eventually cause oncologists to begin undercoding visits rather than taking the time to make sure documentation supports a higher-level code that could be justified but ultimately gets reduced. Gary Bien, the practice administrator at Hematology/Oncology of Indiana, [...]

Four Often-overlooked Billing Opportunities   (December 1999)

With reduced reimbursements for many of the services oncologists provide, practices need to be sure they are exploring all available opportunities. Listed below are four possible hidden pockets of revenue oncology practices can ethically take advantage of. 1. Chemo Chair Visits: Chemo Chair Visits can be billed using 99212-99213 (office or other outpatient visit for the evaluation and management of an established patient). We suggest that oncologists round through the chemotherapy infusion area at certain [...]

Reader Question: Reimbursement for Lab Tests   (December 1999)

Question: Whats the best way to avoid delays in reimbursement for lab tests done before chemotherapy?Anonymous Virginia Subscriber Answer: If you put the cancer diagnosis code first (for example, testicular cancer, 186.9) then the V58.1 chemotherapy code, and finally the codes for the various lab tests, you usually can get everything paid for except pulse oximetry (94760). Pulse oximetry is used most often for patients who have dyspnea, which is shortness of breath or distress [...]

Reader Question: Port for Subclavian Catheter   (December 1999)

Question: How do you get paid for accessing a port for a subclavian catheter? Some carriers are denying payment. Anonymous Pennsylvania Subsciber Answer: According to Elaine Towle, CMPE, New Hampshire Hematology/Oncology, accessing a port is not a separately payable service under the Medicare program. Medicare considers this procedure part of the primary service. Other payers, however, may make a separate payment, usually under code 96530. However, you can bill for flushing the port if it [...]

Get Paid for Same-date E/M Service and Chemo Administration by Non-physician Provider   (November 1999)

When a patient presents for administration of chemotherapy, a physician is not usually scheduled to see him or her. But sometimes such attention is called for. However, many oncology practices report it can be challenging to obtain adequate reimbursement for an evaluation and management (E/M) service (99212-99215) provided on the same date as chemotherapy administration (96400-96549). What is optimal coding for this situation? Ron Nelson, PA-C, advisor to the AMA CPT Healthcare Professionals Advisory Committee for [...]

Reader Question: How to Get Reimbursed for Drugs that Lack Codes   (November 1999)

There are times when most oncology practices come across a treatment, drug or supply item that is so new it has not yet been assigned a code. In such cases, the pro-viders should use a code that best resembles the procedure or use codes for unlisted procedures, drugs and supplies. The disadvantage of the first route is that it can produce payment that is not adequate for the time and resources used during the procedure, [...]