Oncology & Hematology Coding Alert

Good news: You can apply many of the same rules you already know for intravenous chemotherapy coding to intra-arterialcoding, too. So take your chemo coding expertise to the next level by adding intra-arterial skills to your arsenal.

Start here: For intra-arterial (IA) chemotherapy, you should choose from the following codes, says Gwen Davis, CPC,associate with Washington-based Derry, Nolan, and Associates.

96420 -- Chemotherapy administration, intra-arterial; push technique

96422 -- ... infusion technique, up to 1 hour

+96423 -- ... infusion technique, each additional hour,(List separately in addition to code for primary procedure)

96425 --" ... infusion technique, initiation of prolonged infusion (more than 8 hours), requiring use of a portable or implantable pump.

Compare 96420-96425 Applications

Push: For an IA chemotherapy push, you should report 96420,says Davis. You should apply the same CPT definitions for a "push" to both IA and intravenous (IV) administration:

(a) "an injection in which the healthcare professional who administers the substance/drug is continuously present to administer the injection and observe the patient"

OR

(b) "an infusion of 15 minutes or less."

Infusion: For infusion by temporary catheter, a physician often places the catheter into the artery supplying blood to the tumor. Infusion code 96422's definition specifies "up to 1 hour," and +96423 specifies "each additional hour." But just as with IV infusion codes, CPT indicates you should report the "additional hour" code "for infusion intervals of greater than 30 minutes beyond one-hour increments," Davis says. So if the infusion lasts one hour and 30 minutes, you should report only 96422 (without adding +96423) because the time has not reached the "greater than 30 minutes" required for +96423.

Pump: Infusion by pump is a common method of intra-arterial administration. Report 96425 for prolonged infusions that require a portable or implantable pump and last longer than eight hours. This code describes only the initial service, so if your practice performs refilling or maintenance, you should choose the appropriate code from 96521-96523, just as you would for an IV pump service. Keep in mind: For Medicare and other payers whose contracts indicate they process claims according to Correct Coding Initiative (CCI) logic, be sure to follow the guidelines in CCI manual chapter 11, section N.5 (www.cms.gov/NationalCorrectCodInitEd). The manual states you shouldn't report 96521-96522 alongside 96425 because 96425 includes "the initial filling and maintenance of a portable or implantable pump."

Focus on Liver For Likely Diagnoses

Two of the more common diagnoses treated by IA chemotherapy are primary liver neoplasm and a secondary liver neoplasm that metastasized from the colon.

"The route of treatment [IA or IV] will not affect the diagnosis codes you use," says Tracy Helget, CPC, in the business office of Medical Associates of Manhattan, PA, in Kansas. The appropriate code for primary liver cancer, such as hepatocellular carcinoma, cholangiocarcinoma, or hepatoblastoma, is 155.0 (Malignant neoplasm of liver and intrahepatic bile ducts; liver, primary).

When the colon neoplasm is primary and the liver neoplasm is secondary/metastatic, the appropriate liver neoplasm code is 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary), says Helget.

Example: A patient presents for chemotherapy to treat a secondary liver neoplasm that metastasized from the primary colon neoplasm. "If the primary focus of the encounter is for chemotherapy, the primary diagnosis listed is V58.11 (Encounter for antineoplastic chemotherapy)," according to ICD-9-CM official guidelines, section I.C, chapter 2.e.2, Helget says. (You can access ICD-9 guidelines online at www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm).

"The next diagnosis listed would be for the site being treated: liver metastasis, 197.7," Helget says, citing chapter 2.b of the guidelines. "And you should also list your primary cancer regardless of it being treated or not," she adds. For a primary colon neoplasm, choose the most appropriate code from 153.x (Malignant neoplasm of colon) or 154.x (Malignant neoplasm of rectum, rectosigmoid junction, and anus).

For this example of a patient presenting solely for chemotherapy aimed at a secondary liver neoplasm, sequence  your ICD-9 codes as follows, Helget says:

V58.11

197.7

the appropriate 153.x-154.x code.