Oncology & Hematology Coding Alert

Tip 1: Remember That a CPT^® Hour Is Actually 90 Minutes.

You should use base codes 96413 and 96422 for infusions up to 90 minutes. Once a single substance infusion goes past that amount (i.e., 91 minutes to 150 minutes), you will use add-on codes +96415 or +96423 with their corresponding base code. Infusions lasting 151 minutes to 210 would receive a second unit of the add-on code and so on.

Tip 2: Reset the Clock When Another Substance Is Given Intravenously.

If the patient is being infused intravenously, and your provider is administering an additional sequential drug, look to using +96417 for the first hour of that administration. For example, supposing the patient receives an intravenous infusion of drug A for 120 minutes, then your provider administers a second drug for another intravenous infusion lasting the same time. You would code this service as 96413 for drug A, +96417 for drug B, and +96415x2 for the additional time infusing both drugs.

But check this out: This is the correct way to code sequential intravenous infusions. You would code concurrent intravenous infusions differently, as you will see in “Know These Codes for Concurrent, Sequential Chemo Infusions” — this month’s “You Be the Coder.”

Tip 3: Know the Separate Code for Intravenous Pushes of a Second Substance

If your provider is performing intravenous pushes of drug A and drug B, you’ll use 96409 and +96411. Pushes have no time-based add-on code as, by definition, a push that lasts more than 15 minutes is considered an infusion.

Don’t forget: For intra-arterial infusions, you will simply add up the entire time, regardless of the number of drugs administered, and bill 96422 and the appropriate number of hour units for +96423 per CPT^® for reporting infusion times.

Tip 4: Know What Counts for Time in Chemotherapy Administration

Many services are included in the infusion codes and cannot be counted into your time calculations. They include but may not be limited to:

Before the service: Time spent educating the patient; time spent preparing the drug, the chemo agent, and the patient.

During the service: Time spent starting the IV, gaining access to the port, monitoring the patient, and administering the concluding flush, including heparin flush.

After the service: Time further spent monitoring the patient or educating about side effects and providing discharge information.

Putting it All Together

Your physician administers the following intravenously: rituximab over 173 minutes (11:27 AM to 02:20 PM), cyclophosphamide over 64 minutes (01:50 PM to 02:54 PM), and doxorubicin over 23 minutes (02:55 PM to 03:18 PM). Additionally, vincristine was given as an intravenous push over a minute. How would you report this?

For the rituximab administration: Total duration is 2 hours and 53 minutes. For the initial hour you report 96413, and for or the additional 1 hour and 53 minutes, you would submit two units of code +96415.

For the cyclophosphamide administration: Total duration is 64 minutes. As this is an additional, sequential infusion of a different drug, you would document this with +96417. As the infusion does not meet the 91-minute threshold, you cannot bill any add-on units.

For the doxorubicin administration: Total duration is 23 minutes. You would submit another unit of +96417 for the same reasons as the cyclophosphamide administration.

For the vincristine IV push: Coding this will depend on the site of the vincristine administration. If the provider does not note a second IV site, you cannot use another initial code. But if the drug is administered at a second site, you will use 96411.