Oncology & Hematology Coding Alert

Question: We administer prophylactics such as potassium, then chemotherapy, then other prophylactics such as Mannitol. Everything is administered by infusion. How should we report this service?

Missouri Subscriber

Answer: Start by billing the primary reason for the encounter, which is 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). The prophylactics are considered sequential administrations, so report +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, up to 1 hour [List separately in addition to code for primary procedure]) for 2009 services for each new mix.

Explanatory notes direct you to report +96367 only once per sequential infusion of the same infusate mix; you can report it twice because you-re administering different prophylactics (potassium and Mannitol).

Change for push: If the administration meets the definition of a "push," report +96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]).

Hydration heads-up: If your staff administers hydration as a secondary or subsequent service in association with the chemotherapy administration through the same IV access, CPT notes direct you to also report +96361 (Intravenous infusion; hydration; each additional hour [List separately in addition to code for primary procedure]), providing staff delivered at least 31 minutes of medically necessary hydration.