Oncology & Hematology Coding Alert

Question: What are the proper codes for the following scenario?
 A patient scheduled for chemotherapy receives 45 minutes of hydration before beginning chemotherapy. The patient then receives an antiemetic infusion for 40 minutes. After this, the patient receives one chemotherapy infusion for an hour and then an infusion of a different chemotherapy drug for 90 minutes. Finally, he receives another antiemetic infusion, this one for 15 minutes.


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Answer: Coding for this scenario requires careful attention to initial and subsequent codes and time requirements. Here's what to do:

Chemotherapy: The patient's primary reason for the visit is the chemotherapy, so consider this (not hydration or the antiemetic) the initial service.

Report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first chemotherapy agent, which took an hour.

For the second chemotherapy agent, report +96417 (- each additional sequential infusion [different substance/drug], up to 1 hour [list separately in addition to code for primary procedure]). Although the descriptor says -up to 1 hour,- only report one unit of this code for the 90-minute infusion. Why: You need more than 30 minutes to code an additional hour, so for two units, you would need to pass the 90-minute mark.

Hydration: For the 45-minute hydration service, report +90761 (Intravenous infusion, hydration; each additional hour, up to 8 hours [list separately in addition to code for primary procedure]). You may report hydration as a secondary service if it takes more than 30 minutes.

Antiemetic: Report the first antiemetic with +90767 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, up to 1 hour [list separately in addition to code for primary procedure]). In this case, the chemotherapy is the primary procedure.

For the second antiemetic, you should report push code +90775 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [list separately in addition to code for primary procedure]).

You need a push code because the second antiemetic took 15 minutes, and you report a push for infusions of 15 minutes or less.