Oncology & Hematology Coding Alert

Question: I have a question regarding pretreatment drugs. Recently, a patient was pretreated with Zofran and Decadron in anticipation of receiving chemotherapy. Unfortunately, due to poor intravenous access, the scheduled treatment with antineoplastic agents Adriamycin and Cytoxan was abandoned. Can we bill the patient's insurance for the pretreatment Zofran and Decadron even though the chemotherapy delivery was interrupted?

Maryland Subscriber

Answer: Yes, it would be appropriate to bill the insurance company for the administration of the chemotherapy premedications. In this case, you may bill for both Zofran and Decadron. You may only bill for one IV administration charge. These two medications are often administered sequentially each over 30 minutes or less. You would therefore bill the insurance company 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour). The diagnosis code would still be the cancer diagnosis and chemotherapy encounter code, V58.1 (Chemotherapy). This encounter code is appropriate because the purpose of the visit was the chemotherapy even though the chemotherapy was not administered.