Reader Question: Chemotherapy Billing   (September 2001)

Question: Can I bill 96408 (chemotherapy administration, intravenous; push technique) with modifier -59 (distinct procedural service) and 96410 (… infusion technique)?Colorado Subscriber
 Answer: When a chemotherapy regimen is prescribed it may require multiple agents to be given at the same visit. It is also common for the chemotherapy drugs to be given using different techniques. A patient may receive one agent via intravenous push and another via an intravenous infusion. An example of this is a [...]

Reader Question: Port Flush   (September 2001)

Question: How can we get paid for port flushes? Can we bill for the supplies used for this service?Kentucky Subscriber  Answer: Medicare will not pay for the flushing of an implantable venous access device, otherwise referred to as a port. It will also not pay for supplies, such as a Port-A-Cath kit, which includes a needle and catheter.  Accessing venous access devices for blood collection and/or Heparin flush for any reason is part of managing the [...]

Use 96410 or E Codes for Infusion Pumps But Not Both   (August 2001)

Oncologists are equipping more of their patients with ambulatory infusion pumps that administer chemotherapy outside of the office. The supplies associated with these pumps are usually reimbursable, but billing for the pumps themselves must be done carefully. You have to take into account where and when the pumps are used and whether the oncology practice owns or rents them.  Depending on several factors, practices should use either chemotherapy administration codes 96410-96423 (the series that describes [...]

Get Paid for the Professional Component of Procedures   (August 2001)

Many oncology practices assume that all procedures that office-based physicians order to be performed in a hospital outpatient facility have both professional and technical components.  The truth is that oncology-related procedures vary as to whether they have one or both components. For example, a special radiation physics consultation (77370) has only a technical component, treatment planning codes (77261-77263) are professional only, and simulations (77280-77295) comprise both. You can append modifier -26 (professional component) to these [...]

You Be the Coder: Bone-Marrow Transplant   (August 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: For a bone-marrow transplant (BMT) done in a hospital, it is my understanding that the nurse hangs the bag, and the doctor remains in the area for 30 minutes to an hour. The nurse monitors the patient, and if any complications arise, the physician is called.  Can we bill 38240 or 38241 for this procedure, [...]

Use Modifier -Q5 for Substitute-Physician Services   (August 2001)

If done correctly, oncologists who are not in the office can bill for services the practice renders – as long as a substitute physician is present and available for supervision or face-to-face care.   Modifier -Q5 (service furnished by a substitute physician under a reciprocal billing arrangement) tells Medicare that the practice made specific arrangements with a substitute physician. The two physicians, however, must be clear on their payment arrangements to avoid billing Medicare for the same [...]

Reader Question: Chemotherapy Drugs by Push Technique   (August 2001)

Question: For chemotherapy drugs that must be “pushed” through an intravenous line, can we bill 96408 with modifier -59 and 96410?Pennsylvania Subscriber
 Answer: You can report separate codes when chemo-therapy is administered by different techniques. If your oncologist administers a push and an infusion to a patient on the same day, you must append modifier -59 (distinct procedural service) to the push code to indicate that a different drug was used. Intravenous push chemotherapy administration is reported [...]

Reader Question: CT Scans   (August 2001)

Question: If a radiation oncology practice owns a CT scanner, can the practice be reimbursed if it’s used to help prepare simulations, even though they are not diagnostic?New Mexico Subscriber  Answer: If the radiation oncology practice owns the scanner, it can be paid for the technical component, that is, obtaining the CT images. Code 76370 (computerized tomography guidance for placement of radiation therapy fields) designates a treatment plan that includes a CT scan to localize the [...]

Reader Question: Family Counseling   (August 2001)

Question: Can we bill family counseling if the patient is not present?New Hampshire Subscriber
 Answer: Medicare coverage guidelines (Coverage Issues Manual 35-14) state that family counseling services are covered only when the primary purpose is to treat the patients condition. To bill Medicare, a physician can only consider the time spent counseling the patient and/or family members about patient care – and not the course of the disease only.  The Medicare Carriers Manual (MCM), Section 15501, C, [...]

Reader Question: Office Consultation   (August 2001)

Question: How should we code for an initial visit for a patient referred to us for colon cancer screening? We tried 99241(office consultation) with V76.49 (other sites) but were denied. Nebraska Subscriber Answer: Code 99241 is used most frequently for documentation of an office consultation for a new or established patient. But the physician must perform a problem-focused history and examination with basic and clear-cut medical decision-making. Usually, the patient presents with a problem or set [...]