Oncology & Hematology Coding Alert

List all infusions and accurately time each infusion.

Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc. shares more about medication administration to help you strengthen your coding. Take a look at our expert’s answers below and compare them to yours.

Answer 1: The correct answer is option A, 96409 (Chemotherapy administration, intravenous, push technique; single or initial substance/drug) - Q1, 96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]), 96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour [List separately in addition to code for primary procedure]) and 96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]) times two.

According to CPT® guidelines, when reporting multiple infusions, injections, or combinations, you report only one initial service code unless the protocol requires that your physician uses two separate IV sites.

The initial code should be the one that best describes the key or primary reason for encounter. You needn’t consider the order in which your physician administered the infusions. Also remember that you do not report the administration of saline unless according to CPT® guidelines, the fluid used to administer the drug(s) is considered therapeutic in nature, not given concurrently and the need for hydration is noted.

An intra-arterial or intravenous push is an injection in which your physician or healthcare professional administering the injection is present for the administration and observation of the patient, typically over an infusion period of 15 minutes or less.

You report code 96409 for IV push of bortezomib (Velcade). Since, the patient gets bortezomib as part of clinical trial, you append the Q1 modifier for this Medicare patient.

You submit code 96367 for administration of pamidronate (Aredia) through the IV route over the first hour. You also submit code 96366 for the additional 40 minutes of infusion.

Answer 2: The correct answer is option A, J2430 (Injection, pamidronate disodium, per 30 mg) x 2.

You do not submit HCPCS level II code for borteomib (Velcade), as the patient gets this medication as part of the clinical trial.

For pamidronate disodium 30 mg, you submit HCPCS Level II code J2430. Since your physician administers 60 mg of this medication, you submit 2 units of J2430. You do not report the fluid or saline used to administer the medication.

Answer 3: The correct answer is option D, V58.11 (Encounter for antineoplastic chemotherapy), 288.60 (Leukocytosis, unspecified).

For an encounter of chemotherapy administration, you submit ICD-9-CM code V58.11. The diagnosis documented by your physician is leukocytosis. You report this with ICD-9-CM code 288.60. This seems the most appropriate choice for the diagnosis of leukocytosis as your physician has not documented the type of white blood cells.

The ICD-10-CM codes corresponding to V58.11 and 288.60 are Z51.11 (Encounter for antineoplastic chemotherapy) and D72.829 (Elevated white blood cell count, unspecified), respectively.

Best practices: To arrive at the right codes, you’ll need to adopt a stepwise approach to report what your physician does. A good rule of thumb is to list all infusions and confirm for how long each one lasted. Next, you should submit the HCPCS codes for all medications, and finally list diagnosis codes for conditions that your physician documents.