Oncology & Hematology Coding Alert

Keep a close eye on infusion times.

When you’re staring at a claim for a liver cancer patient, you may be tackling intra-arterial (IA) chemotherapy coding. This is a technique physicians use to administer the drug directly into the artery.

Simplify this complicated chemotherapy procedure with these tips.

Tip 1: Some Injections Are Simply a Push

First, you want to familiarize yourself with a common term you will come across during IA chemotherapy. The term “push” is otherwise known as an injection, but it is more clearly defined by CPT^®. CPT^® states a “push” is an injection in which the healthcare professional who administers the substance/drug is continuously present to administer the injection and observe the patient. Alternatively, it is also defined as an infusion of 15 minutes or less.

For cases when you have determined a push was performed, report code 96420 (Chemotherapy administration, intra-arterial; push technique). Use this code for cases such as a nurse administering IA infusion of chemotherapy slowly over five minutes. Stay the course, and don’t be confused by the term “infusion.” Since the administration in this case indicates ‘slowly over 5 minutes’ both the time and as documented would indicate the administration was a push, not an infusion.  If in doubt of the technique used, documentation improvement should be sought to clarify and support the proper coding of the service specifically.

Tip 2: Keep Track of Infusion Time

One of the principle tips for IA chemotherapy infusions is to keep a close eye on the infusion times. Different times mean different codes, says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, associate partner, Pinnacle Enterprise Risk Consulting Services LLC

A more common procedure involves an infusion lasting more than 15 minutes. For this, you should use code 96422 (Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour) for the first hour.

The cutoff limit is 16 minutes for 96422. This means if the infusion lasts 16 minutes, you count an hour for infusion unless the documentation indicates an IV push technique was used as defined by CPT^®. Additional infusion intervals, beginning at 1 hour and 31 minutes, require add on code 96423 (Chemotherapy administration, intra-arterial; infusion technique, each additional hour [List separately in addition to code for primary procedure]).

Even for a 45-minute infusion, you are still going to report 96422. If an IA infusion takes one hour and 30 minutes, you report only 96422. Do not report add on +96423 in this situation, because the total time beyond the first hour is only 30 minutes and does not meet the 31-minute threshold requirement to report an additional hour of infusion services.

3. Don’t Forget About the Pump Payment

Longer infusions do occur. Sometimes a provider will perform one of these prolonged infusions for more than eight hours. For these procedures, a portable or implantable pump is typically used in outpatients. To report for this pump, use code 96425 (Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump). This administration infusion code is acceptable whether you own the pump or not.

Your provider might offer to refill or maintain the IA portable or implantable infusion pump too. In this case, you should keep in mind the following codes depending on the service provided.

• 96521 (Refilling and maintenance of portable pump)
• 96522 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [eg, intravenous, intra-arterial])
• 96523 (Irrigation of implanted venous access device for drug delivery systems).

The Correct Coding Initiative (CCI) bundles these codes into code 96425. You cannot report the codes together if the maintenance or irrigation was provided on the same day as the infusion. You should only report 96523 if the irrigation was the only service provided on that day, at that encounter and for that site.

4. Know How to Navigate Initial and Sequential Therapies

If you’re looking for initial or sequential IA chemotherapy codes, you won’t find them. CPT^® does not offer these codes. This means IA chemotherapy codes 96422 with 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) can be reported on the same day for the same patient.