Oncology & Hematology Coding Alert

Question: Can I report 96413 and 96521 on the same day?

Codify Member

Answer: Under certain circumstances, you may report both 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and 96521 (Refilling and maintenance of portable pump) on the same date of service.

The key is that the hour of IV chemotherapy infusion (96413) and the pump refill or maintenance (96521) must be distinct.

Code 96521 is bundled into 96413 by Correct Coding Initiative (CCI) edits. To override the edit, you should append modifier 59 (Distinct procedural service) to 96521.

Tip: Code 96521 is specific to refilling or performing maintenance for a portable pump. There is a separate code for initiating a pump infusion that takes more than eight hours: 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump). Code 96416 is not reportable on the same date as 96521.