Oncology & Hematology Coding Alert

Question: Can I bill 96408 (chemotherapy administration, intravenous; push technique) with modifier -59 (distinct procedural service) and 96410 (... infusion technique)?

Colorado Subscriber

 
Answer: When a chemotherapy regimen is prescribed it may require multiple agents to be given at the same visit. It is also common for the chemotherapy drugs to be given using different techniques. A patient may receive one agent via intravenous push and another via an intravenous infusion. An example of this is a breast-cancer patient who is prescribed CAF -- Cytoxan, J9070-J9097; Adriamycin, J9000; and Fluorouracil, 500 mg. (5-FU), J9190. Some physicians administer both Cytoxan and Adriamycin via an IV infusion, while the 5-FU is given with an IV push. Adriamycin can be given by IV push as well. The physician determines the administration method in his or her order.
 
The CPT 2001 manual states that separate codes should be reported for each parenteral method of administration used when chemotherapy is administered by different techniques. Therefore, you should be billing both codes when both techniques are used. Applying modifier -59 should ensure identification of these as separate procedures.