Oncology & Hematology Coding Alert

Red flag: Reporting 96415 for a 90-minute infusion will land you in hot water Don't let National Colorectal Cancer Awareness Month go by unnoticed--it's a good time to sharpen your coding skills for the third most common cancer. Get started by taking on these real-world examples. Size Up Your Skills With This Palliative Scenario Scenario 1: A patient with metastatic colorectal cancer (primary neoplasm of the rectosigmoid junction, secondary neoplasm of the liver) presents for palliative chemotherapy. The provider administers 350 mg/m2 irinotecan intravenously in 500 mL D5W (5 percent dextrose in water) over 90 minutes.

ICD-9: Report V58.11 (Encounter for antineoplastic chemotherapy) as your primary diagnosis code, says Jean Acevedo, LHRM, CPC, CHC, senior consultant for Acevedo Consulting in Delray Beach, Fla.

Then report the primary neoplasm of rectosigmoid junction with 154.0 (Malignant neoplasm of rectum, rectosigmoid junction, and anus; rectosigmoid junction) and the secondary neoplasm of liver with 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary), Acevedo says.

You can also add V66.7 (Encounter for palliative care) as a fourth code--ICD-9 tells you to code the underlying disease first. Caution: If you omit chemotherapy encounter code V58.11 and report palliative care code V66.7, some payers won't cover the chemotherapeutic drug. Report V58.11 to make it clear that the patient presented for chemotherapy, Acevedo says.

CPT: Ensure proper procedure coding by paying attention to the time recorded for the irinotecan infusion. Because the patient received the chemotherapy infusion for 90 minutes, you should report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). But don't report +96415 (- each additional hour, 1 to 8 hours). You-d need an additional 31 minutes to report this -additional hour- code, according to CPT guidelines.

A 90-minute administration means that you have one hour plus 30 minutes, which falls short of the 96415 requirement by one minute. Helpful: Remind your providers to record exact times for infusions. Rounding down an infusion from 31 minutes to 30 shortchanges your practice.

HCPCS: If you code for the drugs you use, report J9206 (Irinotecan, 20 mg). Remember to factor in the 20 mg included in the descriptor when you choose your units.

Example: The oncologist uses nine 40-mg vials (360 mg)--he administers 350 mg irinotecan and wastes the remaining 10 mg. The 360 mg used divided by the 20 mg in the J9206 descriptor reveals that you should report 18 units of irinotecan. Warning: Payers have varying policies on coding for drug waste. Check with yours to determine their preferences, such as recording [...]