Oncology & Hematology Coding Alert

Question: We had a Medicare patient who received chemotherapy infusions in the morning and then came back in the afternoon with nausea, vomiting, and weakness. The physician met with the patient and ordered hydration and Ativan, which were then administered. Should I report one initial code overall, or may I report two initial codes for the date because there are two encounters?

Alabama Subscriber

Answer: You may report one initial code per encounter.

The Correct Coding Initiative (CCI) manual, Chapter XI, Section N, uses the term “encounter” in discussing initial codes: “The CPT^® codes 96360, 96365, 96374, 96409, and 96413 describe ‘initial’ service codes. For a patient encounter only one ‘initial’ service code may be reported unless it is medically reasonable and necessary that the drug or substance administrations occur at separate intravenous access sites” (the manual is available from the Downloads section at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/).

You will need to append an appropriate CCI modifier (such as modifier 59, Distinct procedural service) to the second initial code to indicate it was from a separate encounter, requiring the time and effort of providing IV site access a second time.