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Posted By Kelly on 03-13-2006, 16:32:00 in Oncology
Good Monday Morning! (not really)
How would the list code the following claim.
Patient comes in for hydration only for two hours and the Procrit injection.
The patient was hydrated for two hours (90760 and 90761). The patient received the Procrit via IV Push. Would you bill out 90775 or 90774?
Thanks!

Kelly Reibman, CPC
Mariette Austin, PhDMD
Comments (7)
Posted By Cindy on 03-15-2006, 18:03:00
You may want to check your local policy, for example:



http://www.oknmmedicare.com/provider/sb/clarisalinfB.htm

"Based on evaluation of Local Coverage Decisions, payment for Saline
Infusion with Non Chemotherapy Drug Administration will be allowed for
the following criteria: If the PDR requires saline for Non Chemotherapy
Drug delivery in certain volumes Medicare will cover the Saline use.
Therefore Medicare will provide separate payment for J7050 (infusion,
normal saline solution 250cc) of 250cc or greater when required in the
drug delivery by the PDR."

These are just general infusion stuff...



http://www.umd.nycpic.com/cgi-bin/bookmgr/bookmgr.exe/BOOKS/DR001E06/FRO
NT



http://www.medicarenhic.com/cal_prov/med_review/drugs.htm



Can I bill separately for IV saline infusions during chemotherapy
administration?

Answer 1:

No, you should not bill for the IV saline infusion (CPT codes 90780 and
90781) when administered at the same time as chemotherapy infusion (CPT
codes 96410, 96412, or 96414). The saline used to mix/infuse
chemotherapy drugs for administration is included in the practice
expense and is not separately payable.


Of course, your local policies would take precedence...

Hope this helps,

Cindy

Cindy C. Parman, CPC, CPC-H, RCC

President, AAPC National Advisory Board

Coding Strategies, Inc.

Phone: 1.877.6.CODING

Fax: 770.445.0407

cindy.parman@codingstrategies.com


visit our website at: www.codingstrategies.com
Posted By Kelly on 03-13-2006, 21:10:00
Cindy,
You always know how to explain it. Thanks!!!!!

Kelly Reibman, CPC
Mariette Austin, PhDMD
Posted By Cindy on 03-13-2006, 20:08:00
The problem that we see with this involves the parenthetical notes in
the CPT Manual. According to the instructions for code 90775:

Use 90775 in
conjunction with 90765
, 90774
, 96409
, 96413
)

Since code 90760 is not listed as a 'primary' code for the subsequent
push, there is no recognized relationship for the payor. Based on one
inquiry to a payor rep, they would expect the primary service to be
90774, with the hydration as a secondary service only. It seems like
this is an oversight in the CPT Manual, and it may be possible to
educate the payors not to accept the parenthetical notes as gospel. It
appears that hydration is considered a secondary reason for the
encounter whenever any other type of administration is performed during
the same encounter.

Based on these instructions, the payor probably expects to see the
Procrit injection as the primary reason for the encounter, and hydration
as a secondary service:

90774

90761 x2


I'm not saying this is correct - just potentially what the payor is
looking for...


Cindy

Cindy C. Parman, CPC, CPC-H, RCC

President, AAPC National Advisory Board

Coding Strategies, Inc.

Phone: 1.877.6.CODING

Fax: 770.445.0407

cindy.parman@codingstrategies.com


visit our website at: www.codingstrategies.com
Posted By Tiffany on 03-13-2006, 19:52:00
Try billing 90774 with 90761 x 2.

Per CPT the only initial codes that can be used in conjunction with
90775 is 90765, 90774, 96409 and 96413.

90761 can be used as an add-on code to 90760, 90765, 90774, 96409 and
96413.

Hope this helps!

Tiffany
Posted By Kelly on 03-13-2006, 19:07:00
I did check out the CPT book and you are correct. CPT definately needs to
clarify this. Thanks!
Posted By Kelly on 03-13-2006, 18:41:00
I did do that and 90775 was denied as usual. The denial message was
C)-107-related or qualifying service was not previously paid or identified
on this claim.
Posted By Tiffany on 03-13-2006, 17:35:00
90775

Tiffany
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