Oncology Coding Article – Outpatient Prospective Payment System (OPPS)

Specialty Groups — Oncology

Medical Oncology Code Changes

There is a major change to the way hospitals will report chemotherapy administration under the Outpatient Prospective Payment System (OPPS) for 2004.

According to the November 7, 2003 Federal Register (page 63448):  “For 2004 OPPS we [CMS] will continue the use of Q0081, Q0083, and Q0084 to pay for drug administration, for both packaged drugs and separately paid drugs. These drug administration codes will continue to describe the administration of drugs per visit. As recommended by the APC Panel, we will cease to make payment under OPPS for Q0085 and will instead permit the services described by Q0085 to be billed using both Q0083 and Q0084. We believe that this will result in appropriate payment for drug administration because for 2004 OPPS we will pay separately for drugs which the per day median cost is in excess of $50 per day.”

In a separate section of this document, CMS continues: “Instead, when a hospital furnishes chemotherapy infusion and chemotherapy via another route, the hospital will bill and be paid for both Q0083 and Q0084.“ In addition: “With regard to the issue of how often in a day Q0081, Q0083 and Q0084 may be billed, each of these codes is to be used to report all services in a single visit, regardless of the number of drugs administered during that visit.”

Cindy C. Parman, CPC, CPC-Hcparman-3433173
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.