Revenue Cycle Insider

Question: What is the difference between intra-arterial chemotherapy (IAC) and regular intravenous (IV) chemotherapy, and how is IAC administration coded?

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Answer: The difference between IV chemotherapy and IAC is simply that IV chemotherapy is generalized, meaning the cancer drug introduced circulates around the patient’s entire body; whereas IAC is introduced into an artery that supplies blood to the tumor, making it ideally suited to target localized tumors. For example, IAC is used 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.

CPT^® lists four codes you would use to document IAC. Like the regular IV chemotherapy administration codes, the key to using the IAC codes is documenting the time spent:

• 96420 (Chemotherapy administration, intra-arterial; push technique) is a push, defined by CPT^® as “an infusion of 15 minutes or less” the same as an IV chemotherapy push. With pushes, CPT^Ò goes on to note that “the healthcare professional who administers the substance/ drug … [must be] continuously present to administer the injection and observe the patient.” And if the push lasts beyond the 15-minute threshold for the service, you will still report 96420.
• 96422 (… infusion technique, up to one hour) is for IAC infusion administration up to one hour. You 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 31 minutes.
• +96423 (… infusion technique, each additional hour) 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.
• 96425 (… infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump) represents the initiation of a prolonged IAC infusion lasting more than eight hours. Per the code descriptor, prolonged infusion requires more than eight hours and the use of a portable or implantable pump.

Remember: Despite the note accompanying 96425, refilling and maintenance of the portable or implantable pump required for a prolonged IAC infusion, 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)), and 96523 (Irrigation of implanted venous access device for drug delivery systems), are bundled into 96425 and cannot be separately reported on the same date of service.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC