Oncology & Hematology Coding Alert

Question: What's my coding for a patient with primary neoplasm of the rectosigmoid junction and secondary neoplasm of the liver who receives palliative chemotherapy of 350 mg/m2 irinotecan intravenously in 500 mL D5W (5 percent dextrose in water) over 90 minutes?

Rhode Island Subscriber

Answer: For 90 minutes of chemotherapy infusion, you should report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

Don't overcode: You should not report +96415 (- each additional hour) in addition to 96413. A 90-minute administration means that you have one hour plus 30 minutes, which falls short of the 96415 requirement by one minute. You-d need an additional 31 minutes beyond the initial hour to report this "additional hour" code, according to CPT guidelines.

Why accuracy matters: Remind your providers to record exact start and stop times for infusions. Rounding down an infusion from 31 minutes to 30 shortchanges your practice.

If you code for the drugs you use, you may also report J9206 (Irinotecan, 20 mg). Remember to factor in the 20 mg included in the descriptor when you choose your units.

Example: The oncologist uses nine 40-mg vials (he administers 350 mg irinotecan and wastes the remaining 10 mg). The 360 mg used divided by the 20 mg in the J9206 descriptor reveals that you should report 18 units of irinotecan.

Double check: Payers have varying policies on coding for drug waste. Check the specific payer to determine its preference, such as recording wasted drugs on a separate line or by appending modifier JW (Drug amount dis-carded/not administered to any patient).

You should cite a primary diagnosis of V58.11 (Encounter for antineoplastic chemotherapy).

Describe the primary neoplasm of rectosigmoid junction with 154.0 (Malignant neoplasm of rectum, rectosigmoid junction, and anus; rectosigmoid junction) and the secondary neoplasm of liver using 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary).

Finally, you can also add V66.7 (Encounter for palliative care) as a fourth code.

Caution: If you omit chemotherapy encounter code V58.11 and report palliative care code V66.7, some payers won't cover the chemotherapeutic drug. You should cite V58.11 to clarify that the patient presented for chemotherapy.