Oncology & Hematology Coding Alert

Question: Which CPT codes should I report for the following case?

" 71 minute Leucovorin infusion

" 5 minute push of 5FU during Leucovorin infusion

" After the push and infusion, pump initiation for a 46 hour 5FU continuous infusion.

Colorado Subscriber

Answer: Your claim should include the following:

" 96409 -- Chemotherapy administration; intravenous,push technique, single or initial substance/drug

" +96367 -- 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)

" 96416 -- Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump.

Rationale: Your first step is to choose the initial code that describes the key reason for the visit. In this case, 5FU is a chemotherapy drug and Leucovorin is not, so you should home in on the 5FU services. You may report a pump initiation and a separate initial code on the same date, so you should report the 5FU push as your initial code.

The Leucovorin runs as an infusion and does not merit a chemotherapy infusion code, so you should report +96367. Finally, report the pump initiation with 96416.

Tip: Check your payers policy on reporting the pump disconnection service. Payers often consider disconnection included in 96416, but some payers may allow you to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient&) for the visit.