Advanced Search

Oncology & Hematology Coding Alert

Injection Code Smarts Sharpen Chemo Claims

Published on Fri Oct 08, 2004

Nonchemo injections have their own code set

When checking a procedure report, you should know what key terms distinguish a chemotherapy injection from an infusion. Also, when the nurse performs a chemo injection and therapeutic injection in the same session, you'll need to know how many codes to report.

In the last issue of Oncology Coding Alert, we looked at several chemotherapy delivery methods in "Chemotherapy Administration: Your Top-3 Coding Problems Solved."

This month, we continue our look at chemo administration with some tips on what to report (and what not to report) when coding for chemo injection sessions.

Chemo Injection Defined

"An injection is a forceful, direct introduction of a drug or other fluid into the patient's bloodstream or body tissues," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga. If that "drug or fluid" is a chemotherapy agent, CPT has a code for the situation. 

When to Use 96400

When a nurse (or physician, depending on the situation) injects chemotherapy drugs into a patient either subcutaneously or intramuscularly, you should report the procedure with 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia). Also don't forget to report the appropriate J code for the chemotherapy drug(s) on your claim.

Example: A patient with breast cancer reports to the office for treatment. The physician subcutaneously delivers 40 milligrams of the anti-cancer drug Taxotere. On the claim, you should:

  • report 96400 for the injection.

  • report J9170 (Docetaxel, 20 mg) x 2 for the drug supply.
     
    Another tip: If a nurse or physician administers multiple drugs during a single injection, report 96400 only once, but include the HCPCS codes for each drug delivered.

    Don't Confuse Injection With Infusion

    Problem: Given that their definitions are somewhat similar, you could easily confuse chemotherapy injections and infusions (CPT codes 96410-96414), especially if you're reading an especially large or messy procedure note or flow chart. However, if you want your coding to be accurate, you must remember to keep the two definitions straight.

    "Injections are very similar to infusions in the sense that both techniques administer fluids and medications to the patient intravenously," according to the HCPCS Coding Clinic, Fourth Quarter 2001. But that is more or less where the similarities end. Injections and infusions may be similar procedures, but they're not identical - and code confusion can send your claim to Denial Land.

    Coder's definition: "A chemo injection is the drug being injected directly into the skin. Chemo infusion is the drug being infused directly into the vein and/or port intravenously," says Kelly Reibman, CPC, billing manager at the office of Mariette Austin, PhD, MD, in Easton, Pa.

    Injection or Infusion? Delivery Method Often Tells

    Hot tip: If you're stuck on whether to use an injection or an infusion code, check the delivery method: 96400 is only for subcutaneous or intramuscular chemo administration. Also, be sure to look for the amount of fluid the oncologist administered. Typically, injections use less than 50 milliliters of fluid per session, while most infusions require 50-plus ml of fluid, Parman says.

    Injection example: The oncologist's notes indicate that he intramuscularly administered 25 ml of Lupron to a patient with prostate cancer.

    In this scenario, the doctor delivered the Lupron intramuscularly, and the Lupron amount was less than 50 mg, which means the encounter was almost certainly a chemo injection, which should be reported with:

  • 96400

  • J9217 (Lupron).

    Infusion example: The notes indicate administration of 50 ml of Lupron and 75 ml of Zoladex to a patient with prostate cancer, and that the drug administration took 55 minutes.

    Since the patient received 125 mg of fluids and the encounter took nearly an hour, this scenario has all the earmarks of a chemo infusion session, which should be reported with:

  • 96410 - Chemotherapy administration, intravenous; infusion technique, up to one hour

  • J9202 - Zoladex

  • J9217 - Leuprolide acetate (for depot suspension), 7.5 mg.

    Note: When infusion time is less than an hour, payers may require modifier -52 (Reduced services) on 96410.


    Correction appeared in February 2005 issue as:
    The article contained an example of a physician subcutaneously delivering 40 milligrams of the anti-cancer drug Taxotere. However, Taxotere cannot be delivered subcutaneously.

    • Other Articles in this issue of

    Oncology & Hematology Coding Alert

    View All