Oncology Article – New G Codes for Outpatient Hospital (OPPS) Clinical Trial Patients

Specialty Groups — Oncology

And Still More G Codes!

Program Memorandum A-02-129 (January 3, 2003) lists new G codes for outpatient hospital (OPPS) clinical trial patients. The following code should be billed when only experimental drugs are administered as part of a Medicare qualifying clinical trial. When an experimental drug is administered in conjunction with payable drugs on the same day, the appropriate drug administration code should be used instead of the G code.

G0292 – Administration(s) of experimental drugs(s) only in a Medicare qualifying clinical trial (includes administration for chemotherapy and other types of therapy via infusion and/or other than infusion), per day

In addition to drug administration, it may be necessary for the patient to have surgery as part of the clinical trial. The following codes are used to report the surgical procedure, and will ensure that the hospital receives reimbursement for the fixed costs associated with providing the service under the clinical trial.

G0293 – Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a Medicare qualifying clinical trial, per day

G0294 – Noncovered surgical procedure(s) using either no anesthesia or local anesthesia only, in a Medicare qualifying clinical trial, per day

Remember that diagnosis code V70.7, examination of participant in clinical trial, must be reported on the claim as a diagnosis other than the primary diagnosis for clinical trial patients.

Reprinted with permission from the Journal of Oncology Management March/April issue. 

Cindy C. Parman, CPC, CPC-Hcparman-8378835
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.