Oncology & Hematology Coding Alert

Question: How should I code a report that shows an intravenous chemotherapy infusion started at 10:16, stopped at 12:01 because the patient was unwell, restarted at 1:35 and then completed for the day at 3:05?

Arizona Subscriber

Answer: You should report one unit of 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and two units of +96415 (... each additional hour [list separately in addition to code for primary procedure]).

Why: You should consider this one infusion service, calculating the time based on when the infusion was actually running. Don't include the break time in your calculation.

The 10:16 to 12:01 infusion lasted one hour, 45 minutes, and the 1:35 to 3:05 infusion lasted one hour, 30 minutes.

Add one hour, 45 minutes and one hour, 30 minutes, and you get three hours, 15 minutes.

Code 96413 takes care of hour one, and the two 96415 units cover hours two and three. That leaves a remaining 15 minutes, but you can't report an additional 96415 unit unless you have an infusion interval of greater than 30 minutes beyond a one-

hour increment.

Kudos: Your staff appears to be recording exact start and stop times, if the 10:16 and 12:01 start and stop times are any indication. Encourage them to keep up the good work so you can be sure you-re choosing the most accurate codes and units.