Oncology & Hematology Coding Alert

Question: A patient recieved Cisplatin 100 mg for 2 hours, Taxotere 120 mg for 1 hour 1 minute, Aloxi 0.25 mg IVP, Benadryl 25 mg IVP, Decadron 20 mg IVPB for 31 minutes, Mannitol 12.5 gm for 31 minutes, normal saline 1000 ml. To infuse the medication, the physician used a port. 

A central venous access a port was set up at 9:35 with 20 gauge, blood return flushed with 10 cc NS and 5 ml heparin flush solution. Hydration (1000 ml at 250 ml/hr) was begun 9:35am and lasted until 11:47am. 

The timings of the administration were as follows: Aloxi IVP 0.25 mg at 11:15am, Benadryl 25 mg at 11:17 am IVP, Decadron 20 mg IVPB 11:18 am -11:47 am, Mannitol 12.5 gm 12:50pm-1:12pm, Taxotere 120 mg 11:48 am -12:49pm, Cisplatin 100 mg 1:13pm-3:12pm.

Can you guide for the best possible codes for these medications including administration codes, if any? Also can we bill for the 10 cc NS and 5 ml heparin flush solution our physician used to flush the port?

New York Subscriber

Answer: Let us begin by coding for the chemotherapy provided. For Taxotere, you report 120 units of J9171 (Injection, docetaxel, 1 mg). This is because the code J9171 applies to each 1 mg of docetaxel. You also report the administration code, 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). Since the infusion lasted more than an hour but not extend more than 30-minutes beyond the 1-hour increment, you would not report and additional hour of infusion time.

For cisplatin, report 10 units of J9060 (Injection, cisplatin, powder or solution, 10 mg) for the 100mg given. Report 1 unit of +96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion [different substance/drug], up to 1 hour [List separately in addition to code for primary procedure]). Since the infusion lasted more than an hour, and extend more than 30-minutes beyond the 1-hour increment, you would report and additional hour of infusion time with code +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]).

Now let’s look at the other medication. For Decadron, report 20 units of J1100 (Injection, dexamethasone sodium phosphate, 1mg) and for the administration, report 1 unit of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]).

For mannitol, report 1 unit J2150 (Injection, mannitol, 25% in 50 ml).  You again report +96367 again for this infusion.

For Aloxi, i.e. palonosetron, your physician has prescribed 0.25 mg. you need to convert this to mcg (250 mcg) to calculate the number of units of the correct code. You report 10 units of J2469 (Injection, palonosetron HCl, 25 mcg). This is administered as a push, so report +96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]).

For Benadryl, you report 1 unit of J1200 (Injection, diphenhydramine HCl, up to 50 mg) and another unit of code +96375.

Be careful when you pick up codes for saline administration. To report the administration of saline that was done concurrently with other drugs, you can bill for 102 minutes. Now you need to check the medical record and confirm if your physician wrote a specific order for medically necessary hydration (reportable) or was it just to keep a line “open” (not reportable). The Correct Coding Initiative (CCI) manual, states, “If therapeutic fluid administration is medically necessary (e.g., correction of dehydration, prevention of nephrotoxicity) before or after transfusion or chemotherapy, it may be reported separately.” Unless you have documentation indicating the saline was ordered for a therapeutic purpose, you should consider it included in the other therapeutic infusions rather than reporting it separately or query the physician to be certain. If you do have the needed documentation, report 1 unit of J7030 (Infusion, normal saline solution, 1000 cc) and report unit of +96361 for the first hour and another unit of +96361 for the remaining 40 minutes.

You cannot separately report for the 10 cc NS and 5 ml heparin flush solution used in the port. Irrigation of a venous access device has minimal effort associated with its provision, hence you should report 96523 (Irrigation of implanted venous access device for drug delivery systems) only when no other service (e.g., evaluation and management, chemotherapy) has been provided along with the irrigation of the implanted venous access device for drug delivery.