Oncology & Hematology Coding Alert

Question: How do I code hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreduction surgery? Should I use 96446, and do I need to add the 77605 code for heating the chemo?

AAPC Forum Participant

Answer: As of Jan. 1, 2024, CPT^® introduced 96547 (Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)) and its add-on code, +96548 (… each additional 30 minutes (List separately in addition to code for primary procedure), which you will use to document HIPEC services. Note that these services are time-dependent, so you will have to verify how long your oncologist took to perform the procedure before choosing the correct code(s).

Per CPT^® Assistant Volume 33: Issue 12 (Dec. 2023), “the work described by the HIPEC procedure [96547] is different than the work described in code 96446 [Chemotherapy administration into the peritoneal cavity via implanted port or catheter] in which a port and a catheter are implanted for subsequent chemotherapy that is typically provided in an office/outpatient setting.”

To emphasize the difference, CPT^® revised the descriptor for 96446 — a change which also took effect on Jan. 1, 2024 — “to indicate that chemotherapy administration is via an ‘implanted’ port or catheter.” For even greater emphasis, CPT^® also added “cross-reference parenthetical notes … following codes 77605 [Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm] and 96446 to direct users to codes 96547 and +96548 for reporting HIPEC procedures,” again per CPT^® Assistant.