Oncology & Hematology Coding Alert

Question: For chemotherapy drugs that must be "pushed" through an intravenous line, can we bill 96408 with modifier -59 and 96410?

Pennsylvania Subscriber

 
Answer: You can report separate codes when chemo-therapy is administered by different techniques. If your oncologist administers a push and an infusion to a patient on the same day, you must append modifier -59 (distinct procedural service) to the push code to indicate that a different drug was used.
 
Intravenous push chemotherapy administration is reported with 96408 (chemotherapy administration, intravenous; push technique). If IV infusion techniques were used during the same treatment visit, report separately, as appropriate, 96410 (infusion technique, up to one hour), +96412 (infusion technique, one to eight hours) and 96414  (infusion technique, initiation of prolonged infusion, requiring the use of a portable or implantable pump). Code the drug with the appropriate J code.
 
For each individual  "push"-administered drug, report 96408.
 
Medicare pays for only one administration by push (96408) per encounter regardless of how many drugs are administered. Other payers might pay 96408 for each drug administered by the push technique. Medicare will pay for both a push and an infusion on the same day, but only if different drugs are involved.