Oncology & Hematology Coding Alert

Question: I’m confused by the chemotherapy infusion timing. What’s the difference between coding for an hour, two hours, or infusions lasting nine hours?

Tennessee Subscriber

Answer: For the infusion of a single substance that lasts up to an hour, you submit code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

Subsequently, for every additional hour (and portions thereof of 31 minutes or more) of infusion of the same substance, you report the add-on code +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]).

You will typically report prolonged infusions for those that last more than 8 hours and using a portable or implantable pump. For a prolonged infusion, you report code 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump).