Oncology & Hematology Coding Alert

Question: We had a patient who received cisplatin in the office and then was sent home with a pump containing 5FU (fluorouracil). We are billing 96410 for the infusion. Can we also bill 96414 on the same day for the initiation of prolonged infusion using a portable pump?

Michigan Subscriber

Answer: Yes, you would bill 96410 (Chemotherapy; infusion, up to one hour) for the infusion of cisplatin. You would also bill 96414 (Chemotherapy administration; infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump) for the initiation of the 5-fluorouracil. You should append modifier -59 (Distinct procedural service) to the 96414 code. You should indicate in the data field for 96414 that 5-fluorouracil was the drug administered.

If you are not initiating the infusion of 5-fluorouracil but rather are refilling the pump, you need to use CPT 96420. Again, remember to use modifier -59.

You can also bill for the supplies and the pump (if you own and are providing the pump). For this and more information related to infusion pumps, refer to the article "Pump Up Your Billing Reimbursement for Chemo Delivery" in this issue of Oncology Coding Alert.