Oncology & Hematology Coding Alert

Question: A physician at our clinic is treating a patient for liver cancer and ordered an intra-arterial infusion as treatment. One of the nurses administered a 90-minute IA chemotherapy infusion. I know that there are several IA chemotherapy codes, but which one is the right choice for this situation?

West Virginia Subscriber

Answer: Because your patient received an intra-arterial (IA) chemotherapy infusion that lasted one hour and 30 minutes, you should report only 96422 (Chemotherapy administration, intra-arterial; infusion technique, up to one hour).

More information: Navigating the IA chemotherapy administration codes can be a little tricky. Here are some more useful things to keep in mind when you-re coding for these procedures.

For example: You should use add-on code +96423 (- infusion technique, each additional hour [list separately in addition to code for primary procedure]) to report each additional infusion interval lasting more than 30 minutes beyond a one-hour increment. In the situation you describe, you wouldn't report 96423 along with 96422 because the total time for the IA chemotherapy infusion is only 30 minutes -- not "more than 30 minutes" -- beyond a one-hour increment.

Useful advice: These timing rules for IA infusion codes 96422 and 96423 are the same as those for the IV infusion codes you use more commonly, such as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (- each additional hour).