Oncology & Hematology Coding Alert

Keeping time will guide your to the right code.

The last thing you want to do with your liver cancer coding is to shortchange your provider. You might find yourself incorrectly reporting the intra-arterial (IA) chemotherapy, a technique that administers the drug directly into the artery. This procedure involves a series of codes that, once mastered, can prevent your practice from losing out on reimbursements.

Determine When an Injection is Considered a Push

First, you want to familiarize yourself with a common term you will come across during IA chemotherapy. The term “push” is otherwise known as an injection, but it is more clearly defined by CPT®. CPT® states that a “push” is an injection in which the healthcare professional who administers the substance/drug is continuously present to administer the injection and observe the patient. Alternatively, it is also defined as an infusion of 15 minutes or less.

The IA chemotherapy typically involves a push as opposed to a standard injection. For cases when you have determined a push was performed, report code 96420 (Chemotherapy administration, intra-arterial; push technique). Use this code for cases such as a nurse administering IA infusion of chemotherapy slowly over five minutes. Stay the course, and don’t be confused by the term “infusion.” According the American Association of College of Pharmacies (AACP), this is still a push, and you should accurately report this as 96420.

Keep Track of Infusion Time

One of the principle tips of IA chemotherapy infusions is to keep a close eye on the infusion times. Different times mean different codes.

A more common procedure involves an infusion lasting more than 15 minutes. For this, you should use code 96422 (Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour) for the first hour.

The cutoff limit is 16 minutes for 96422. This means that if the infusion lasts 16 minutes, you count an hour for infusion. Additional infusion intervals, beginning at 1 hour and 31 minutes, you will add the code 96423 (Chemotherapy administration, intra-arterial; infusion technique, each additional hour [List separately in addition to code for primary procedure]).

Even for 45 minute infusions, you are still going to use 96422. If an IA infusion time takes one hour and 30 minutes, you report only 96422. Do not add 96423 with 96422. This is because the total time is only 30 minutes, and does not go over that time limit.

Don’t Forget About the Pump Payment

Longer infusions do exist. Sometimes a provider will perform one of these prolonged infusions for longer than eight hours. For these procedures, a portable or implantable pump should be used. To report for this pump, use code 96425 (Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump). This infusion code is acceptable whether you own the pump or not.

Your provider might offer to refill or maintain the IA portable or implantable infusion pump too. In this case, you should keep in mind the following codes depending on the service provided.

• 96521 (Refilling and maintenance of portable pump)
• 96522 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial])
• 96523 (Irrigation of implanted venous access device for drug delivery systems).

The Correct Coding Initiative (CCI) bundles these codes into code 96425. You cannot report the codes together if the maintenance or irrigation was provided on the same day of the infusion. You should only report 96523 if the irrigation was the only service provided on that day.

Know How to Navigate Initial and Sequential Therapies

If you’re looking for initial or sequential IA chemotherapy codes, you won’t find them. CPT® does not offer these codes. This means that IA chemotherapy codes 96422 with 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) can be reported on the same day for the same patient. Do not bundle these codes together.