Oncology & Hematology Coding Alert

Question: What are the appropriate codes for the first day of the FOLFOX4 regimen?

New Jersey Subscriber

Answer: You should base your final coding decision on the documentation and the exact services your practice provides. But as a starting point, the FOLFOX4 regimen typically involves the patient receiving Oxaliplatin and folinic acid concurrently over two hours, followed by a 5-FU bolus on day one.

That same day, the patient begins a 22-hour infusion of 5-FU, often using an ambulatory pump. In this scenario, your day one claim would include:

• The Oxaliplatin (J9263, Injection, oxaliplatin, 0.5 mg) with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (... each additional hour [List separately in addition to code for primary procedure])

• The 5FU (J9190, Injection, fluorouracil, 500 mg) with +96411 (... intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure])

• The concurrent folinic acid (J0640, Injection, leucovorin calcium, per 50 mg) with +96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; concurrent infusion [List separately in addition to code for primary procedure]).

Key to concurrent: CPT Assistant (November 2005) indicates that the concurrent infusion code is appropriate for multiple infusions provided through the same IV line.

CPT Assistant (November 2006) clarifies that "to report a concurrent administration, the drugs cannot simply be mixed in one bag; there must be more than one bag." If the drugs are mixed in a single bag you would report a single administration code.

Additionally: If you also report the ambulatory pump initiation, use 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump).