Oncology & Hematology Coding Alert

Normally, intrathecal pumps are delivery systems for pain management, but under some circumstances chemotherapy may be administered through an intrathecal delivery system.

It is quite uncommon to use a pump for intrathecal administration, says Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant in New Orleans. However, when intrathecal chemotherapy is employed, it is delivered through a lumbar puncture (96450) or an implanted subarachnoid or intraventricular reservoir (96542).

Intrathecal chemotherapy occurs when the cancer is site-specific, says Dianna Hofbeck, RN, CMM, president of North Shore Medical Inc., in Abescon, N.J. For example, Hofbeck recalls the case of a patient who had a melanoma in his spine. "The oncologist built a shield around his spine and administered chemo intrathecally directly into the spinal tumor."

Hofbeck employed careful coding and special documentation, submitted by hand, to obtain reimbursement. She wrote a detailed letter covering the patient's age and other appropriate markers that supported payment. In addition, the doctor clearly wrote that this was the patient's last chance. Dramatizing the risk the insurance company was taking by not paying for the treatment resulted in payment, Hofbeck says.