Oncology & Hematology Coding Alert

Question: I saw a treatment plan saying the patient will receive chemotherapy by spinal infusion. Which chemotherapy administration code will be appropriate for these infusions?

Vermont Subscriber

Answer: The proper code for chemotherapy by "spinal infusion" is 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture).

CNS is the abbreviation for central nervous system, which includes the spinal cord. Intrathecal means within a sheath, so it's through the sheath of the spinal cord into the space that contains cerebrospinal fluid.

Watch out: The code definition explains that the code covers both the administration and the spinal puncture involved. For example, the oncologist may perform a spinal puncture to administer chemotherapy directly into a spinal tumor.

In some cases, another physician will perform the spinal puncture. Experts recommend that in that case, the oncologist should append modifier 52 (Reduced services) to 96450, and the other physician should report the spinal puncture services separately.