Posted: December 29, 2004
Please review the revised, new and deleted codes that will effect your practice in 2005. Be sure and check the 2005 HCPCs book for full narratives of the codes. Watch for changes to the descriptions, as well as quantity changes to the currently used J-Codes.[download printable version here]
J1564 – Immune Globulin 10mg, REVISED
J2469 - Aloxi 25mcg - NEW
J9035 - Avastin 10mg - NEW
J9041 – Velcade 0.1mg – NEW
J9055 – Erbitux 10mg - NEW
J9305 – Alimta 10mg - NEW
G0328 – Colorectal Screening
G0344 - “Welcome to Medicare” Exam
G0001 has been deleted for 2005. Use 36415 to report routine venipuncture.
G0363 – Port Flush
Billing Tip:
•This code is not payable with any other service performed on the same day.
G0364 – Bone marrow biopsy and aspiration performed through the same incision on the same day
Billing Tip:
•You will bill the bone marrow biopsy with 38221 and the aspiration with G0364.
•If through separate incisions or separate sites, continue to use the 38220 and 38221 with the -59 modifier.
Infusion - Hydration:
G0345 – Initial infusion, up to 1 hour, hydration
G0346 – Each additional hour
Billing Tip:
•G0345 is billed if it is the “initial treatment” or the main treatment reason the patient is being hydrated.
•If used with other drug treatment (i.e. Cisplatin) use G0346 with a -59 modifier.
•If patient has more than 1 hour of hydration prior to the other treatment use the correct number of units to reflect the hours used for hydration (i.e 2 hrs of pre-hydration = 2 units of G0346).
Infusion and Injection -Therapeutic/Diagnostic:
G0347 – Initial infusion, up to 1 hour, therapeutic/diagnostic
G0348 – Each additional hour
G0349 – Addiitonal sequential infusion, up to 1 hour
G0350 – Concurrent infusion
G0351 – Injection, single/inital, therapeutic
G0352 – Injection, intra-arterial
G0353 – IV push, therapeutic/diagnostic
G0354 – Each additional push
Infusion and Injection – Chemotherapy:
G0355 – Injection, chemotherapy, non-hormonal
G0356 – Injection, chemotherapy, hormonal
G0357 – IV push, single/inital, chemotherapy
G0358 – Each additional push
G0359 – Initial infusion, up to 1 hour, chemotherapy
G0360 - Each additional hour
G0361 – Initiation of prolonged chemotherapy infusion
G0362 – Additional sequential infusion, up to 1 hour, chemotherapy
Billing Tip:
•You must determine what the “primary procedure” is for the infusion session (chemotherapy, non-chemotherapy or hydration).
•You can only bill one (1) initial infusion code per infusion session.
•The first hour of infusion of anti-neoplastic agents provided for the treatment of non-cancer diagnoses or substances such as monclonal antobody agents or other biologic response modifiers is billed under G0359, chemo administration. You do not need a “J9” code to bill for the high complexity infusion code.
•Submission of the appropriate J-Codes must accompany the appropriate procedure codes.
•Medical necessity must be well documented and the administration record complete.
•Use the correct neoplasm code and V58.1 with the use of chemo administration codes, as well as appropriate diagnoses justifying any non-chemo infusion.
•Medicare made a determination regarding how to appropriately calculate infusion time. Infusions that run greater than 30 minutes into the current hour of infusion should be rounded to the next hour. If less than 30 minutes into the current hour of infusion, round down to the previous full hour. This applies to all types administration.
Medicare will allow $130.00 per patient, per chemotherapy infusion or chemotherapy push.
