# IV infusions



## cpccoder2008 (Aug 11, 2009)

What if the IV infusions are two different drugs running concurrently for 2 hours and another chemo push ?

Would that be coded as 96413, 96417, 96411 ?? Also when coding for chemo do you need to add modifier's to these procedures ?


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## mitchellde (Aug 11, 2009)

I am short my book right now but it should be initial infusion, concurrent infusion and subsequent push.


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## cristig4 (Aug 11, 2009)

cpccoder2008 said:


> What if the IV infusions are two different drugs running concurrently for 2 hours and another chemo push ?
> 
> Would that be coded as 96413, 96417, 96411 ?? Also when coding for chemo do you need to add modifier's to these procedures ?



Since the two chemo drugs are in the same bag and concurrent you would bill 96413 - 1 unit for the first hr, 96415 - 1 unit for the second hr and 96411 - 1 unit for the additonal push


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## cpccoder2008 (Aug 11, 2009)

thank you,, at least i got 2 out of 3 correct. That mean's i am on the right track !! lol


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## cpccoder2008 (Aug 11, 2009)

Do you have to apply modifier's to chemo codes ?? Also what if a patient is sent home with a pump, do i bill 96416 and the next day when the complete treatment or return the pump i don't bill anything ??


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## mitchellde (Aug 11, 2009)

cristig4 said:


> Since the two chemo drugs are in the same bag and concurrent you would bill 96413 - 1 unit for the first hr, 96415 - 1 unit for the second hr and 96411 - 1 unit for the additonal push



Were they in the same bag? I understood when you said concurrent that it was two drugs two bags.


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## cpccoder2008 (Aug 11, 2009)

mitchellde said:


> Were they in the same bag? I understood when you said concurrent that it was two drugs two bags.



I honeslty don't know, i'll have to ask the nurses.


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## cpccoder2008 (Aug 12, 2009)

I would say no according to this article they are seperate. http://en.wikipedia.org/wiki/FOLFOX

Oxaliplatin 85 mg/m² IV infusion in 250-500 mL D5W and leucovorin 200 mg/m² IV infusion in D5W both given over 120 minutes at the same time in separate bags using a Y-line, followed by 5-FU 400 mg/m² IV bolus given over 2-4 minutes, followed by 5-FU 600 mg/m² IV infusion in 500 mL D5W (recommended) as a 22-hour continuous infusion.

After reviewing this i came up with 96413, 96417, 96411, 96416. The 96413 is for the initial infusion of Oxaliplatin, the 96417 for the subsequent concorrent Leucovorin, the 96411 for IV push and 96416 for the infusion over 8 hours.


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## cristig4 (Aug 12, 2009)

I thought you had two chemotherapy drugs.  Leucovorin is not a chemotherapy drug.  The following is from the leucovorin website:
What is Leucovorin?
Leucovorin is a drug that can be used either to protect healthy cells from chemotherapy or to enhance the anti-cancer effect of chemotherapy. 
In that respect the codes would be 96413 - initial hr for oxal, 96415 - second hr oxal, 96368 - concurrent infusion for the leucovorin.  If there is an actual push of a chemotherapy drug you can bill 96411.  If it is a push of another med such as aloxi that is coded with a 96375.
If pt is hooked up to a pump then yes you bill 96416 the day they start the pump.  You may charge a 99211 for disconnecting the pump the following day if there are no other qualifying services.
There should be no modifiers for the chemo codes.
Hope this helps, Cris


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## cpccoder2008 (Aug 12, 2009)

We are billing for the Oncologist only. This is a brand new service to our company so we aren't too familiar with it's coding so i really don't know what drugs are chemo and which one's aren't. I get a list of the chemo drugs used and a charge sheet that looks like a anesthia sheet starting the start and stop time and they way it was administered. This patient had an Oxaliplatin and Leucovorin infusion with a fluorouracil push and sent home with a CADD pump with fluorouracil. Does that make sense ?? This is my second chemo i am trying to code and the first one had a fluorouracil and Leucovorin push. I just thought they were both chemo drugs because on my charge ticket it is listed under chemo drugs, not with the pre-medication drugs or other drugs used. We don't bill for nurse's so we can't bill the 99211, we are only billing the admit of the drugs for the physician. I was told i couldn't bill for anything else because we don't own the drugs or the nurse's. I am sooo very confused !!!


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## cpccoder2008 (Aug 12, 2009)

Do you know where i can get a list of chemo drugs so i know which one's to bill for ?


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## Jennifer Rucker (Oct 30, 2009)

Different carriers allow different classifications on Leucovorin.  So you will have to look at your carrier to see if it will allow Leucovorin as chemo--mine does.


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## mitchellde (Oct 30, 2009)

cpccoder2008 said:


> We are billing for the Oncologist only. This is a brand new service to our company so we aren't too familiar with it's coding so i really don't know what drugs are chemo and which one's aren't. I get a list of the chemo drugs used and a charge sheet that looks like a anesthia sheet starting the start and stop time and they way it was administered. This patient had an Oxaliplatin and Leucovorin infusion with a fluorouracil push and sent home with a CADD pump with fluorouracil. Does that make sense ?? This is my second chemo i am trying to code and the first one had a fluorouracil and Leucovorin push. I just thought they were both chemo drugs because on my charge ticket it is listed under chemo drugs, not with the pre-medication drugs or other drugs used. We don't bill for nurse's so we can't bill the 99211, we are only billing the admit of the drugs for the physician. I was told i couldn't bill for anything else because we don't own the drugs or the nurse's. I am sooo very confused !!!



So you are billing for the physician, who has ordered this service to be performed in an outpatient facility?  Is this correct?  or inpatient facility?  Then is your physician actually starting the IV, and staying with the patient and charting the start times stop times and patient condition thru the entire process?  Because if not then your physician cannot bill the infusion charges, those go to the facility.  And as far as which drugs are chemo, look in your PDR.


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## FRALCNIK (Nov 20, 2009)

*infusion coding*

when billing for two seperate sequential drugs is the correct coding

96367 x 2, or 96367 x 1, 96367-59 x 1 ?

there are some discrepencies in our office.

thanks, nikki


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## ciphermed (Nov 20, 2009)

I would not use the modifier -59, it does not appear to be necessary.  Below the code it indicates...

"Report 96367 only once per sequential infusion of the same infusate"

each reporting of 96367 appears to indicate a different drug

Hope this helps,


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## kat_232 (Jul 14, 2010)

I realize this is a year old, but in case anyone is using this thread for reference:

Oxaliplatin- 96413, 96415 (1 hr, 31 min til 2 hr, 30 min)
Leuc- 96368 (not chemo, but basically always concurrent w/ oxaliplatin and under therapeutic/diag)
IV push Fluoro- 96411
5FU pump initiate- 96416


99211 when disconnecting 5FU, just as someone else said, unless more services qualify a higher CPT.


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## rross (Jul 22, 2010)

I was told the 96521 was to be used because it includes disconnect.  Is that not correct?  But then I read the heading  "Codes 96521-96523 may be reported when these devices are used for therapeutic drugs other than chemotherapy". That statment makes me think the 96521 can't be used when adminstering chemo, but under 96416 it states "For refilling and maintenance of a portable pump or implantable infusion pump or reservoir for drug delivery, see 96521-96523)

Is that why you say to use the 99211 when disconnecting the pump?


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## abc1099 (Jul 23, 2010)

Leucovorin when given concurrently with Oxaliplatin is billed as 96368 x 1.  Time does not matter with that code - the most you can bill is 1.  Of course, the Oxaliplatin is billed 96413 x 1 and any additional hours are billed 96415.


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## hnroberts (Jul 23, 2010)

As a quick tip... the infusible chemo drugs are J9***, if you ever see those J9*** codes you'll know they are chemo.  When the patient comes in to have their pump d/c'd you can bill a 96521.  You need to really study the drugs to become familiar with what's chemo and what's non-chemo.  Good luck!


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## lpetrova (Jul 24, 2010)

The chemo drugs start with J9xxx. 

This is how you would code for the FOLFOX regimen: 96413, 96415 for Oxaliplatin, 96368 for Leucovorin (J0640 - non chemo drug) running concurrently and always in a separate bag (please note that once in a while you might come across the scenario where Oxaliplatin will be given for 1hr 31min and they would let Leucovorin run for an additional 30+ minutes (same start time). You still would bill 96368 times one unit (no 96368 x 2 or 96368+96366). 96411 for 5FU (push) and 96416 with 59 modifier for 5FU that goes into pt's pump. The place of service on 5FU that goes into the pump should be 12 (to reflect that the drug is given at home - i forgot how it is worded exactly). However, you might want to check with the payers - in our area we have one that insists on not changing the place of service (their logic is that the drug was initiated in the office, therefore, place of service - 11 - should reflect that) so we oblige. 

Best regards


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