ASCO & Palmetto/J1MAC News

The following information has been received by ANCO.


****ASCO NEWS****
The American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) partnered to develop a process based on consensus to draft the first Standards for Safe Chemotherapy Administration. The premise for standard development was that administration of neo-plastic agents is complex and can be fraught with potential patient safety issues. Although other standards, guidelines and policy statements exist, standards to improve quality and safety of chemotherapy administration, both oral and parenteral, have not been established in quantified, measureable terms. When published and incorporated by hematology/oncology practices, the goal of improved quality and safety for patients receiving chemotherapy can be realized.

The draft Standards will be available for comment through March 13, 2009. In the last two months, the ASCO/ONS Steering Committee refined, clarified and streamlined the Standards. A survey tool for public comment and the PDF document can be accessed by clicking: http://research.zarca.com/k/RsTUTRsSPPsVXVTPsPsP

Please read the Standards (PDF) and Background document, and click the URL to provide your comments on the survey tool.

Your comments are extremely valuable and will be analyzed by the ASCO/ONS Steering Committee for inclusion in the Standards. The final Standards and an article describing their development will be submitted for publication in ASCO and ONS journals.


****PALMETTO/J1MAC NEWS****
Upon learning of incorrect denials of the new hydration and therapeutic, diagnostic, and prophylactic drug administration codes (963xx) from ANCO and MOASC, Palmetto/J1MAC has issued the following Alert to providers.

New 2009 CPT Codes 96360, 96361, 96365-96368, 96372-96375, may have been denied in error for dates of service 1/1/09 - 1/27/09, due to the system denying services submitted with Evaluation & Management Services billed with the 25 modifier and one of the Chemo Administrations/Non-Chemotherapy Drug Infusion & Drug Injection Services. The services should have been allowed.

Applies To Procedure Code(s):
Chemo Administrations/Non-Chemotherapy Drug Infusion & Drug Injection Services: 96360, 96361, 96365, 96366, 96367, 96368, 96372, 96373, 96374, and/or 96375

billed with

E/M services: 92012-92014, 99201-99205, 99212-99215, 99217-99223, 99231-99236, 99238-99239, 99241-99245, 99251-99255, 99291-99292, 99304-99307, 99308-99310, 99315-99316, 99324-99328, 99318, 99334-99337 and/or 99347-99350.

Palmetto/J1MAC Action:
The E & M codes must be submitted with the 25 modifier if billed with one of the Chemo Administrations/Non-Chemotherapy Drug Infusion & Drug Injection Services.

Reason Code:
97 Payment adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

Remark Code:
N20 Service not payable with other service rendered on the same date.

Provider Action:
No action required. A mass adjustment will be made to all incorrectly denied claims for dates of service 1/1/09 through 1/27/09.