Oncology & Hematology Coding Alert

Question: One of our oncologists would like to bill for the mixing of chemotherapy using 96545. However, the CPT manual clearly states that the preparation of chemotherapy agents is included in the administration code. If that is the case, how should it be used?

New York Subscriber

Answer: Chemotherapy administration is time-consuming, and it has been deemed appropriate to use 96545 with 96410-96414 (administered from one hour up to eight hours) in a setting where chemotherapy is administered up to one hour or more. The majority of payers, other than Medicare and Aetna, recognize this code.

Traditionally, 96545 (provision of chemotherapy agent) has been chargeable once a day, for the acquisition or provision of a chemotherapy agent and has been interpreted as a code that helps to defer the inventory management, storage and handling of chemotherapy agents. It has also been referred to as the mixing code, because many practices have a pharmacist who does the mixing, while the nurses are responsible for setting up and monitoring the drugs as they are infused. When charging for the filling and maintenance of a portable or implantable pump, 96545 can also be used with 96414 (infusion technique, initiation of prolonged infusion, [more than eight hours] requiring the use of a portable or implantable pump), 96520 (refilling and maintenance of portable pump), or 96530 (refilling and maintenance of implantable pump or reservoir).

This question was answered by Phyllis Klein, president of P.K. Administrative Services, a Lakewood, Colo.-based medical billing agency and president of the Association of Oncology and Hematology Administrators.