Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

chemotherapy billing

Chen Posted Thu 11th of August, 2011 21:35:34 PM

Hi,

I am setting up our own billing for chemotherapy. I have some questions.

A patient that comes in for taxol for 3 hours and then carbo for one hour- is that

initial chemo x 1 hour (96413x1) and followed by subsequent chemo x 3 hours (96415x3)

or

initial chemo x 1 hour (96413 x 1) and subsequent chemo x 2 (96415x2) hours followed by
iv infusion of meds x 1 hour( 96365x1)?

Does the chemo time- is that TOTAL chemo time or how does that work?

Also how do you assign a value to E0780? I looked everywhere with staff and we can't find that . A local practice charges 100 dollars for E0781 - which is outpatient infusion pump time. E0780 for us would be infusion pump time IN OFFICE- less than 8 hours.

Thanks,

SuperCoder Answered Fri 12th of August, 2011 17:23:40 PM

Plz refer to:
http://codingnews.inhealthcare.com/hot-coding-topics/is-96413-96365-ok/

Chen Posted Sat 13th of August, 2011 00:48:38 AM

I am unable to read the entier article, but thanks that was sooo clarifying.

So in this case, these are TWO different chemo drugs,
three hour taxol and one hour carbo
so it would be 96413x1 and 96415x3.

If I have another med on top of that, lets say, I give IV zometa- which I don't think it is considered chemo, I would code as 96366 (as aditional drug) for one hour. Of course this is all going through the very same iv.

If you can cut and paste the article here for me, it is helpful because so far I am not able toa ccess that BOLT website.

Thanks again,

CH~

SuperCoder Answered Sat 13th of August, 2011 02:40:31 AM

CPT guidelines state, “When administering multiple infusions, injections or combinations, only one ‘initial’ service code should be reported, unless protocol requires that two separate IV sites must be used.
***
The easiest way to think of this is, if we are making more than one stick to the patient, we bill more than one initial code.

***

You are absolutely right, the first two chemotherapy drugs given through same IV access, so based on that you need to selected code: 96413x1 and 96415x3.
Now, you are adding a non-chemo through same IV access, so 96366 will be billed as an add on code for 96413.

***
Different Scenario: If this non-chemo had been through a different IV access, then you would bill 96365-59

***

Summary of Guidelines:-
Many payers indicate that when you report two initial codes because each requires a separate access site, you should append modifier 59 (Distinct procedural service). So you may need to append modifier 59 to the secondary “initial” code to indicate the separate IV sites for each infusion in this case.
For example, your claim may include the following:
96413 – Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96365-59 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.

Chen Posted Sat 13th of August, 2011 07:38:41 AM

I am so glad I can come here and ask questions.

Please comment on the last sentence of the first entry:

Also how do you assign a value to E0780? I looked everywhere with staff and we can't find that . A local practice charges 100 dollars for E0781 - which is outpatient infusion pump time. E0780 for us would be infusion pump time IN OFFICE- less than 8 hours.

How do I bill for E0780- meaning in house use of infusion pump? I noted medicare does not have a fee, in general I guess that is because Medicare does not reimburse for that?

Thanks,

SuperCoder Answered Mon 15th of August, 2011 14:40:30 PM

I am submitting a guideline from a very very old pupblication years back, but I think it is still valid and relevant today in the context of Ecodes for Infusion pumps. Billing this in Office setting has been a controversial issue always:-

***
Oncology practices that have been billing for both chemotherapy administration and the use of infusions pumps and have had difficulty getting reimbursed for the latter may be running into trouble for a good reason they may be wrong when they bill and expect to be reimbursed for both.
*
Using infusion pumps in the office, whether external pumps or internal pumps. The proper way to bill for using infusion pumps during in-office chemotherapy is to use codes 96413-96417 (Chemotherapy administration, intravenous infusion technique....). On the other hand, if a practice sends a patient home with a pump, it cannot use the chemotherapy infusion codes (96413-96417) because there was no office administration of chemotherapy drugs. Instead, Medicare considers the administration of the chemotherapy agent to be self-administered and the provider is entitled to bill only for the cost of the drug itself.
*
You cant get there from here billing both chemotherapy administration and the use of infusion pumps.
*
The next billing opportunity is the E/M service associated with the office visit the patient made to receive the pump and learn how to use it. Of course, the requirements of an E/M visit must be met. If the patients physician was not present during this visit, use 99211, the lowest level visit for an established patient, because code 99211 does not require a physicians presence. Before correctly billing for a higher level of service, 99212-99215, a physician must be present and the three components history, examination, and medical decision-making must be completed and documented.
*
Another billing opportunity is the rental of the infusion pump. Some practices may be using E codes incorrectly to bill for rental of the pumps with evaluation and management (E/M) service code 99211 (established patient, office or other outpatient visit). They may make the error of billing the E codes to their Medicare carrier. Instead, they should be billing these codes to their durable medical equipment regional carrier (DMERC), which requires the practice to hold a provider number. (Application forms for a provider number can be obtained either on-line [check the National Supplier Clearinghouse Web site] or by calling National Supplier Clearinghouse at 803-754-3951.) In addition to having a provider number, the practice also must own the pumps it is billing for. If a practice rents the pumps from a supplier, it is the suppliers responsibility to bill DMERC for the pump rental.

Infusion Pump Codes:-
The E Codes cover durable medical equipment but cannot be billed for infusion supplies because Medicare considers their use as part of in-office chemotherapy administration.
Infusion pump billing may include the following E codes: E0779-E0786

Mandy Answered Fri 21st of October, 2011 18:04:35 PM

Here is my scenario; I have a sickle cell patient who receives hydration, appx 3 hours, phenergan, benadryl, and 5 doses of dilauded. Lately she has been receiving desferal for appx 3 hours. What would be the correct administration codes to bill?

Related Topics