Q&A: What does HCPCS code G0498 include?

Q: We are having an internal disagreement regarding HCPCS code G0498 (chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting [e.g., home, domiciliary, rest home, or assisted living] using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion). Our clinical department believes that this code is to be reported in addition to the chemotherapy administration charge. Our coders and chargemaster coordinator disagree and believe it is an all-inclusive code. Who’s right?

A: There has been a lot of discussion regarding the application of HCPCS code G0498. When we look at the components in the code definition, "chemotherapy administration, intravenous infusion technique; initiation of infusion” indicates that this code is for the intravenous infusion of chemotherapy, as it begins with the same language that is usedfor CPT code 96413 (chemotherapy administration, intravenous infusion technique).

The next part of the description states that the infusion is initiated in the physician office or outpatient clinic setting, uses supplies from the office or clinic, including a portable pump. It also specifies that the infusion is continued in a setting other than the office/clinic. Based on the definition, this is a comprehensive code for the chemotherapy administration service, the supplies, and the cost of using the pump. You would not report an additional code for the administration of the chemotherapy via the pump. You would report the chemotherapy drug(s) separately.

The administration of any other chemotherapy, medically necessary hydration, pre-/post-medications, etc., that were administered separately from the pump infusion would be reported separately with the appropriate codes based on the documentation.

CMS notes this clarification in the April OPPS update transmittal.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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