Oncology & Hematology Coding Alert
Limit Your 96523 Use
Question: As I understand it, a port flush 96523 is not charged in conjunction with a subcutaneous injection 90772 because of an NCCI edit. Do you know what that NCCI edit says? When should I report 96523?
Florida Subscriber
Answer: The National Correct Coding Initiative edit that bundles 96523 (Irrigation of implanted venous access device for drug delivery systems) into 90772 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) says the reason for the edit is a -HCPCS/CPT coding manual guideline/instruction.-
Guideline: A note with 96523 in the CPT manual states that you should -not report 96523 if an injection or infusion is provided on the same day.-
And CPT Changes 2006: An Insider's View states:
-Code 96523 was established for reporting irrigation required for implanted venous access devices for drug delivery systems when these services are provided on a separate day from the injection or infusion services, as indicated by the cross-reference following this code.-
Bottom line: You should only report 96523 if the irrigation was the only service provided that day.
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