Question: We're a freestanding facility. How should I report a 61-minute infusion of decitabine for a patient with refractory anemia? California Subscriber Answer: Decitabine is an antineoplastic drug, so unless your payer tells you otherwise in writing, you should report 96413 (Chemotherapy administration,intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the 61-minute infusion. Some payers may maintain that decitabine does not merit a chemotherapy administration drug and may ask for a code such as 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) instead. (The OIG noted this confusing reality in a 2009 report available at
http://oig.hhs.gov/oei/reports/oei-09-08-00190.pdf.) HCPCS: Don't forget to report the drug (sold under the name Dacogen) using J0894 (Injection, decitabine, 1 mg). The entity bearing the cost of the drug should be the one to report it. ICD-9: For the diagnosis coding, depending on [...]
