# How do I bill this Chemo Visit.



## Robert5131 (Mar 10, 2015)

Hello all I have a question. We recently hired a new manager that is helping us bill in our office. He is having me change the way I bill and I need help. He is telling my manager that I am billing incorrectly but I do believe I am billing correctly.
Example Patient. 
Patient is accessed Peripherally (36000)
Ondansetron 16mg (J2405 x16)
Dexamethasone 16mg (J1100x16)
Diphenhydramine 50mg (J1200x1)
Ranitidine 50mg (J2780x2)
Rituxan 700mg (J9310 x7)
Bendamustine 200mg (J9033x200)

The Ondansetron is given first                           10:15a-10:25a
Dex + Diphenhydramine is given concurrently 10:25a-10:35a
Ranitidine is given IVP                                      10:35a-10:35a
Rituxan                                                               10:35-13:00
Bendamustine                                                     13:00 14:45

I billed the infusion codes 
96367
96368
96375
and the chemo codes
96413
96415 X2
96417

He is telling me to bill
96365
96368 mod 59
96374 mod 59

96413
96415 (x4)  mod59
96417

May I please have some opinions on the correct way to bill.


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## mitchellde (Mar 10, 2015)

The odansetron is given first and is less than 15 minutes so there is your initial service as an IVpush you can only one initial service per site per day.
The dex + diphenhydramine hydramine is concurrent which you can bill only once 
Ranitidine is a subsequent push of different substance
The Rituxan is 2 hr 25 min for subsequent chemo admin, as it is subsequent to your initial push.
The bendamustine is your subsequent Chemo admin for 2 units
96374
96368
96375
96415 x 2
96417
This is how I see it going by the times and the codes


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## mitchellde (Mar 10, 2015)

Some will instruct you differently according to the listing criteria but remember that criteria is facility only specific however it would be
96413 Rituxan first hour
96415 Rituxan 2nd hour
96417 Bentamustine
96368 Dex+Dipnhenhydramine
96375 Odansetron
96375-59 Ranitadine


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## Robert5131 (Mar 10, 2015)

mitchellde said:


> Some will instruct you differently according to the listing criteria but remember that criteria is facility only specific however it would be
> 96413 Rituxan first hour
> 96415 Rituxan 2nd hour
> 96417 Bentamustine
> ...



This method makes the most sense. These are all without modifiers right?


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## mitchellde (Mar 10, 2015)

Yes all except for the second push of different substance which will need a 59 to avoid duplicate error.


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## mmathewscpc (Mar 4, 2022)

THERE IS ALWAYS A MISTAKE IN BILLING THE 96374 AND 96375, THE 96374 IS THE INITIAL PUSH OF MEDICATION, THE 96375 IS ADDITIONAL PUSH OF MEDICATION.


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