Oncology & Hematology Coding Alert

Question: What codes should I report when a patient comes in for a cisplatin infusion, and the nurse prehydrates the patient with normal saline for two hours, administers the cisplatin for 55 minutes and then post-hydrates the patient for an hour? Texas Subscriber

Answer: The main reason for the patient encounter is the 55-minute cisplatin administration, so you should report initial chemotherapy administration code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). CPT guidelines explain that you should use an "initial" code for the primary reason for the encounter. Although you can't report hydration incidental to (concurrent with) the chemotherapy administration, you may report hydration given pre- and post-chemotherapy administration when the physician orders it. Because the hydration is secondary to the chemotherapy, you should report +90761 (Intravenous infusion, hydration; each additional hour). A note with 90761 tells you to report the code for "hydration infusion intervals of greater than 30 minutes beyond 1 hour increments," so you should report three units of 90761 because the patient receives hydration for two hours and 55 minutes. Assuming your practice bears the cost for the cisplatin, you should report the appropriate units of J9062 (Cisplatin, 50 mg). You may code the normal saline with J7030-J7050, depending on the product.