Oncology & Hematology Coding Alert

Question: About 30 minutes after starting taxol administration for a patient, the nurse noticed that the pump had leaked onto the floor. It was unclear how much taxol was wasted and how much the patient actually received. Can the administration be billed?

North Carolina Subscriber

Answer: You can bill the administration. The challenge here lies in assigning the code for a push or infusion. By definition, a push technique implies an infusion of 15 minutes or less. The correct code for a push technique is 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug). For administration of drugs that lasts more than 15 minutes and up to 1 hour, you report an infusion. You choose code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for an infusion.

In the situation cited by you, the patient is clearly given an infusion. So the best code is 96413. However, the infusion is not completed as the pump leaked. If the infusion was discontinued at the time the pump error was found, you may append modifier 53 (Discontinued procedure) to code 96413 to account for the discontinuation in the infusion. If the infusion continued after the malfunction was identified and resolved, then the total time the infusion ran would be reported. Look for any additional services provided as described by the care detail including any documented physician intervention.

Tip: If you are coding for the drug (paclitaxel) with code J9265 (Injection, paclitaxel, 30 mg), you should report the entire amount prepared for the administration.