Oncology & Hematology Coding Alert

Question: Do I need a modifier to bill 96413 and +96368 together on the same date of service, and if so, should I use 59 or XU?

AAPC Forum Participant

Answer: The short answer is no. Billing 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) along with +96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)) on the same date of service occurs frequently in oncology. But there is no need to append modifier 59 (Distinct procedural service) or XU (Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service) to one of the infusion codes when you do because +96368 is an add on code to the initial infusion code 96413, and this code pair is not subject to a National Correct Coding Initiative (NCCI) edit.

Remember: You would use the 96413/+96368 code combination in a situation where your patient received a therapeutic drug infusion from a separate bag (infusate) than the chemotherapy drug running during the same time interval. If the patient was receiving the two drugs at the same time from the same bag, you’d use +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)) instead of +96368.