Oncology & Hematology Coding Alert

Good news: They’re a whole lot easier to manage than their IV counterparts.

It’s easy to confuse intra-arterial chemotherapy (IAC) administration coding with coding for the more commonly used IV chemotherapy administration services. Fortunately, IAC coding is much simpler than IV coding, though knowing how to accurately count time when reporting an IAC service is key to implementing the codes correctly.

That’s why we’ve put together this handy IAC FAQ. Read on to get all your IAC coding questions answered.

What Is IAC?

IAC, “also referred to as intra-arterial infusion therapy, involves directly administering chemotherapy drugs into the arteries responsible for supplying blood to a particular organ or tumor … to optimize the localized concentration of chemotherapy drugs within the intended region while concurrently minimizing their systemic exposure, thereby mitigating adverse effects” (Tangella A (October 07, 2023) The Evolving Role of Intra-arterial Chemotherapy in Adult and Pediatric Cancers: A Comprehensive Review. Cureus 15(10): https://www.cureus.com/articles/195624-the-evolving-role-of-intra-arterial-chemotherapy-in-adult-and-pediatric-cancers-a-comprehensive-review#!/). Providers currently use IAC to treat retinoblastomas in pediatric patients, along with primary and metastatic malignant tumors in the liver, gallbladder, and central nervous system; certain head, neck, bladder, gastric, and pancreatic cancers; and non-small cell lung cancer in adult patients.

What Are the IAC Codes and What Do They Include?

CPT^® 2024 lists four codes in the “Intra-Arterial Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration” section:

• 96420 (Chemotherapy administration, intra-arterial; push technique)
• 96422 (… infusion technique, up to one hour)
• +96423 (… infusion technique, each additional hour)
• 96425 (… infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump)

Like all other chemotherapy administration services, these IAC codes bundle local anesthesia; patient preparation; provisioning (preparing the infusate); patient monitoring during infusion; the IV start; access to indwelling IV, subcutaneous catheter, or port; a flush at conclusion of infusion; and standard tubing, syringes, patient education, and supplies.

However, per the note accompanying 96425, refilling and maintenance of the portable or implantable pump required for a prolonged IAC infusion lasting more than eight hours, coded to 96521 (Refilling and maintenance of portable pump), 96522 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial)), or 96523 (Irrigation of implanted venous access device for drug delivery systems), is not bundled into the 96425 service.

But remember: “While refilling and maintenance is not bundled into the payment for the initiation service, they cannot be reported on the same date of service as 96425 includes the initial filling and maintenance,” says Leah Fuller, CPC, COC, managing consultant, Pinnacle Enterprise Risk Consulting Services LLC, Centennial, Colorado.

Also, the guidelines accompanying the 96521-96523 codes specify that 96521-96523 “may be reported when these devices are used for therapeutic drugs other than chemotherapy.”

How Do the IAC Administration Codes Differ?

The main difference between the codes is time, and understanding how to count time in IAC scenarios is the key to correct IAC administration coding. This means time documentation is critical, as it drives the assignment of the correct CPT^® code(s) and units.

96420 is a push, and the same definition of a push applies to IAC administration as it does to IV administration: Per CPT^® guidelines, a push is “an infusion of 15 minutes or less.” This also means “the healthcare professional who administers the substance/ drug … [must be] continuously present to administer the injection and observe the patient” per those same guidelines. If the healthcare professional is continually present, performing the push even after the 15-minute threshold for the service is reached and you have supporting documentation, you will still report 96420.

96422 is for IAC administration up to one hour of infusion. As the code descriptor language says, you will use this code for any IAC administration that lasts from 16 minutes up to the full hour. Note that the services do not have to exceed the traditional CPT^® midpoint threshold of anything over 31 minutes.

+96423 is the add-on code for 96422. Here, you must meet the 31-minute threshold before you can apply it. So, you would report IAC administration lasting one hour and 29 minutes with 96422 only, whereas you’ll report IAC administration lasting one hour and 31 minutes with 96422 and +96423.

Test yourself: Suppose a nurse administers a five-hour, 17-minute IAC infusion. Which CPT^® codes, and how many units of each, should you report?