Oncology & Hematology Coding Alert

CPT's infusion guidelines state that for physician services, "the 'initial' code that best describes the key or primary reason for the encounter should always be reported irrespective of the order in which the infusions or injections occur." For facilities, CPT offers a reporting hierarchy placing chemotherapy infusions above chemotherapy pushes, says Lisa Martin, CPC, CIMC, CPC-I, consultant with Revenue Cycle Inc. in Austin, Texas.

If in doubt, refer to the notes under the CPT code, Martin says. For instance, the CPT note under 96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion ...) indicates you should use it with 96413 (... up to 1 hour, single or initial substance/drug) and not 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance drug), Martin says. In other words, the CPT note doesn't support reporting a chemotherapy infusion subsequent to an initial chemotherapy push.