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Oncology & Hematology Coding Alert

Reader Questions:

Record Reason for Lengthy Infusion Time

Published on Mon Aug 10, 2009

Question: The oncologist ordered a 90-minute chemotherapy infusion service, but the infusion lasted a few minutes longer than that. Is it OK to report the entire infusion time? Louisiana Subscriber Answer: You may report the codes for the entire infusion time, but be sure the medical record notes why the infusion took longer than the prescribed time. You want to be able to prove medical necessity to an auditor because it is not appropriate to extend an infusion time just to increase reimbursement. For example: If the patient has a chemotherapy infusion for one hour and 33 minutes, you would report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour and +96415 (... each additional hour [List separately in addition to code for primary procedure]) for the additional 33 minutes beyond the first hour. As your question suggests, if the patient [...]
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