Oncology & Hematology Coding Alert

Question: How should I code the following case?

• IV Rituxan, 7:30 AM to 10:30 AM
• IV Aloxi and Decadron (mixed in one bag), 10:30 AM to 10:50 AM
• IV Benadryl and Zantac (mixed in one bag), 10:50 AM to 11:10 AM

New Mexico Subscriber

Answer: Your first step is to verify the primary reason for the visit. CPT^® guidelines specify that for physician coding you should choose the "initial" code based on the primary reason for the visit. The physician determines what that primary reason is.

Assuming the Rituxan (rituximab) therapy is the primary reason for the visit, you should consider the following information for the claim.

Rituxan, 180 minutes: Individual payers may choose which agents merit chemotherapy infusion codes rather than non-chemotherapy infusion codes. But for most payers, you should be able to report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour of the three-hour Rituxan infusion.

You also should report +96415 (... each additional hour [List separately in addition to code for primary procedure]) twice for the next two hours of the Rituxan infusion. You should report the agent, a monoclonal antibody, using J9310 (Injection, rituximab, 100 mg).

Aloxi /Decadron, 20 minutes: This mix of the steroid Decadron (J1100, Injection, dexamethasone sodium phosphate, 1 mg) and anti-emetic Aloxi (J2469, Injection, palonosetron HCl, 25 mcg) is a subsequent infusion (that is, it is subsequent to the primary Rituxan infusion).

You should report this service using +96367 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; additional sequential infusion, up to 1 hour [List separately in addition to code for primary procedure).

Benadryl/Zantac, 20 minutes: You should report +96367 again for the mixture of antihistamine Benadryl (J1200, Injection, diphenhydramine HCl, up to 50 mg) and histamine-2 blocker Zantac (J2780, Injection, ranitidine hydrochloride, 25 mg).

Crucial: Don't forget to report the correct number of units for each HCPCS J code representing the medications ordered and administered.