Oncology & Hematology Coding Alert

Question: Following up on "Factor In These Codes for FOLFOX4" in Oncology & Hematology Coding Alert, Vol. 12, No. 1, if we initiate a pump infusion for the patient, should I report 96425 for pump initiation and 96416 for prolonged infusion on the same date?

Michigan Subscriber

Answer: In short, no. Rather than one code describing pump initiation and the other describing pump infusion, the two codes describe basically the same service (initiating a pump infusion that lasts more than eight hours). The distinguishing factor between them is that one is intra-arterial (IA) and one is intravenous (IV):

• IV: 96416 -- Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump

• IA: 96425 -- Chemotherapy administration, intraarterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump.

The patient is not actually in the office for the pump infusion, so you should report the initiation code (96416 or 96425) without reporting an additional infusion code for the pump infusion.

Watch for: If on the same date, the patient receives infusions in the office and your practice also initiates the pump infusion before the patient heads home (and the pump infusion will last more than eight hours), you may report both the in-office infusions and the pump initiation. For example, you may report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and 96416  for the same date of service.