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If you're
billing additional sequential IV pushes with chemotherapy
or other drug administration codes, your life just got a
lot easier.
The
Centers for Medicare and Medicaid Services announced it
will revoke five controversial edits governing drug administration
code G0354 (Each additional sequential intravenous push).
The National Correct Coding Initiative (NCCI) version 11.1,
implemented April 1, bundled G0354 with five codes:
-
G0345 (Intravenous infusion, hydration; initial, up to
one hour)
-
G0347 (Intravenous infusion, for therapy/diagnostic; initial,
up to one hour)
-
G0357 (Intravenous, push technique, single or initial
substance/drug)
-
G0359 (Chemotherapy administration, intravenous infusion
technique; up to one hour, single or initial substance/drug)
-
G0361 (Initiation of prolonged chemotherapy infusion...)
But
NCCI version 11.2, effective July 1, will delete those edits
retroactive to April 1.
Until that change takes effect, you can use the -59 modifier
"to indicate that there was a separate sequential infusion
of a different drug or the same drug at a different time,"
CMS says. Or you can just wait until after July 1 to submit
claims from May or June, and the carriers won't apply the
edits at all.
These
edits would have been a real problem had they applied to
providers going forward, says Andrea Peters, infusion billing
manager with Texas Hematology/Oncology in Dallas.
"They've
cut the reimbursement so much on the drugs, the only way
to make money is with the administration," she notes.
You're should be able to bill an administration code for
each bag you hang and drug you give, so these edits run
counter to that philosophy, she adds.
Separately,
the American College of Cardiology, the American College
of Radiology and the Society for Interventional Radiology
are still talking to CMS about edits that bundle diagnostic
angiograms and venograms with therapeutic angiograms or
venograms (See PBI, Vol. 6, No. 9). CMS wrote back within
60 days, but now the societies are in discussions with CMS,
according to SIR Senior Manager for Reimbursement Dawn Hopkins.
Aside
from bundling the diagnostic and therapeutic scans, which
interventional radiologists often perform on the same day,
CMS has now instructed providers to use modifier -52 (Reduced
services) to overcome these edits.
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