Oncology & Hematology Coding Alert

Question: Should I append modifier 59 when I report multiple chemo or therapeutic infusion/injection codes?

Mississippi Subscriber

Answer: Technically, you should need to apply modifier 59 (Distinct procedural service) to infusion/injection codes in this context only if you are reporting arepeat service (multiple services requiring the same code) that occurred at separate encounters.

For example, suppose a patient receives one nonhormonal anti-neoplastic injection and two hours of a chemotherapy infusion. You report 96401 (Chemotherapy administration, subcutaneous or intramuscular; nonhormonal anti-neoplastic), 96413 (Chemotherapy administration,intravenous infusion technique; up to 1 hour,single or initial substance/drug), and +96415 (& each additional hour) for this encounter. On the same date of service, the patient returns for another non-hormonal antineoplastic injection. You report 96401-59 for this service

Reality: Some coders report problems with payers not accepting subsequent infusion codes, so be sure to work with your payer so you know how to report services in a way its system recognizes.