Oncology & Hematology Coding Alert

Question: Our practice received a denial for 96417 with 96413 and 96415 for Vectibix and Camptosar, along with four therapeutic/prophylactic infusions. Is it possible that the denial resulted from the claim being split? Indiana Subscriber Answer: You-re correct that the claim being split could have caused this denial. Chemotherapy drug Camptosar (J9206, Irinotecan, 20 mg) and monoclonal antibody Vectibix (J9303, Injection, panitumumab, 10 mg) both merit the chemotherapy codes you indicate. That means 96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion [different substance/drug], up to one hour) is the correct code for the sequential infusion. Example: If the patient had a 95-minute Camptosar infusion and a 60-minute Vectibix infusion, you would report for the Camptosar:
- 96413 -- - up to 1 hour, single or initial substance/drug
- +96415 -- - each additional hour
- J9206. For the Vectibix infusion, report 96417 and J9303. Problem: If the payer sees +96417 and only one chemotherapy drug on one part of a split claim, the payer may deny 96417. Solution: You should appeal and include the chemotherapy flow sheet to prove you performed the sequential infusion. Time tip: You also should verify that 96415 was correct in your case. You should report 96415 only when the infusion lasts an additional 31-60 minutes beyond an hour. If the patient received a typical 90-minute infusion for Camptosar, you should not report 96415. A 90-minute infusion is only 30 minutes beyond an hour, not the -greater than 30 minutes- CPT requires.