Oncology & Hematology Coding Alert

If you've got questions about concurrent infusion code +96368, you certainly aren't alone. But we've got answers to help put the confusion behind you. We'll consider two infusion sessions and reveal how one small difference -- the number of bags -- can affect your coding.

Suppose your chart shows the following service:

The Aloxi (an anti-emetic) and Dex (an anti-inflammatory steroid) were in the same bag. You must determine whether to use concurrent infusion code +96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; concurrent infusion [List separately in addition to code for primary procedure]) when reporting the codes for this session.

Not so fast: You should not report +96368 for this session.

To use the concurrent infusion code, the simultaneously administered drugs must be in separate bags, says Melanie Kramer, CPC, with Bozeman Deaconess Health Group patient financial services in Montana.

AMA's CPT Assistant (November 2005) indicates that the concurrent infusion code is appropriate for multiple infusions provided through the same IV line. CPT Assistant (November 2006) clarifies that "to report a  concurrent administration, the drugs cannot simply be mixed in one bag; there must be more than one bag." If the drugs are mixed in a single bag you would report a single administration code.

Rationale: CPT Changes 2006: An Insider's View explains that the AMA intends the administration codes to report the separate work of administration and access and not the inclusion of multiple agents in a bag prepared prior to access.

Result: Report the antineoplastic Velcade push using 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) and the combined Aloxi and Dex infusion with a single unit of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional  sequential infusion, up to 1 hour [List separately in addition to code for primary procedure]), Kramer says.

Note, however, that if you report the drugs, you may report the Aloxi (J2469, Injection, palnosetron HCl, 25 mcg) and Dex (J1100, Injection, dexamethasone sodium phosphate, 1 mg) separately. You would report the Velcade with J9041 (Injection, bortezomib, 0.1 mg).

Lesson: Do not report a concurrent infusion code when the simultaneously administered drugs are in the same infusion bag.

Now suppose your chart shows the following:

The chart states that the Oxaliplatin (chemotherapy drug) and leucovorin (reduced folic acid) were infused concurrently from separate bags. You must determine whether +96368 is appropriate for this case.

What to do: The concurrent administration of Oxaliplatin and leucovorin is one of the few scenarios you'll see where using +96368 is correct, says Cindy Parman, CPC, CPC-H, RCC, principal and cofounder of Coding Strategies Inc. in Powder Springs, Ga.

Providers may infuse these two drugs from separate infusion bags concurrently using a Y-site connector, for example.

Result: Report the Oxaliplatin administration using 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour and +96415 (... each additional hour [List separately in addition to code for primary procedure]) for the second hour, says Kramer.

You may report the concurrent infusion code (+96368) for the leucovorin administration in addition to the Oxaliplatin administration codes, Kramer says. Remember that CPT instructs you to report +96368 only once per encounter, she adds.

And you should assign +96411 (... intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure]) for the 5FU administration.

If you report the drugs, the appropriate HCPCS codes are as follows:

• Oxaliplatin: J9263 -- Injection, oxaliplatin, 0.5 mg

• leucovorin: J0640 -- Injection, leucovorin calcium, per 50 mg

• 5FU: J9190 -- Injection, fluorouracil, 500 mg.

Careful: Note that the simultaneously infused drugs in our example are not both chemotherapy drugs (one is, one is not). "If chemotherapy agents are mixed or given concurrently, the unlisted chemotherapy administration code 96549, Unlisted chemotherapy procedure, should be reported," the November 2005 CPT Assistant article states.

Bonus lesson: You should not report +96368 in the rare case that the patient receives two chemotherapy drugs mixed in the same bag -- look to 96549 instead.