Oncology & Hematology Coding Alert

The patient undergoes the following:

First, Code the Complex Services

As chemotherapy is the primary reason for this visit, you should report the eloxatin IV infusion first with 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 remaining 50 minutes.

After the eloxatin infusion, the oncologist initiated an overnight IV infusion of fluorouracil using a portable pump. You would code this with 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump).

Then, Code the Therapeutic Services

Prior to both chemo services, the oncologist administered dexamethasone and palonosetron, piggybacked for 20 minutes and 22 minutes respectively, each subsequent to each other. That’s two infusions of two drugs at two separate times.

You should report two units of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]), one unit for each therapeutic infusion.

Coding alert: As these two medications were given at different times, they are separately reported. However, had the dexamethasone and palonosetron medications been mixed in the same bag and administered, and given over the same time, you would only report one unit of 96367 for the length of time infused.

Code the Hydration? Not So Fast

Should you report the administration of the D5W solution? The administration route is noted as KVO, meaning keep the line open. So, you should consider the hydration as incidental. In addition, you’ll notice the D5W was infused overlapping the other medication administration times and was not running alone for a medical purpose for at least 31 minutes.

The Final Word

For this scenario, you would code 96413, +96415, 96416, +96367 x 2.