Oncology & Hematology Coding Alert

Question: A patient received Cisplatin 100 mg for 2 hours, Taxotere 120 mg for 1 hour 1 minute, Aloxi 0.25 mg IVP, Benadryl 25 mg IVP, Decadron 20 mg IVPB for 31 minutes, Mannitol 12.5 gm for 31 minutes, normal saline 1000 ml for 100 minutes. To infuse the medication, the physician used a port. This central venous access port was set up with 20 gauge, blood return flushed with 10 cc NS and 5 ml heparin flush solution.

Can you guide for the best possible codes for these medications including administration codes, if any? Also, can we bill for the 10 cc NS and 5 ml heparin flush solution our physician used to flush the port?

New York Subscriber

Answer: Let us begin by coding for the chemotherapy provided.

Taxotere: For Taxotere, you report 120 units of J9171 (Injection, docetaxel, 1 mg). This is because J9171 applies to each 1 mg of docetaxel. You also report the administration code, 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). Since the infusion lasted more than an hour but did not extend greater than 30-minutes beyond the 1-hour increment, you would not report an additional hour of infusion time.

Cisplatin: For cisplatin, report 10 units of J9060 (Injection, cisplatin, powder or solution, 10 mg) for the 100mg given. Report 1 unit of +96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion [different substance/drug], up to 1 hour [List separately in addition to code for primary procedure]). Since the infusion lasted more than an hour, and extend greater than 30-minutes beyond the 1-hour increment, you would report an additional hour of infusion time with code +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]).

Now let’s look at the other medication.

Decadron: For Decadron, report 20 units of J1100 (Injection, dexamethasone sodium phosphate, 1 mg) and for the administration, report 1 unit of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]).

Mannitol: For mannitol, report 1 unit of J2150 (Injection, mannitol, 25% in 50 ml). Report +96367 again for this infusion.

Aloxi: For Aloxi, i.e. palonosetron, your physician has prescribed 0.25 mg. You need to convert this to mcg (250 mcg) to calculate the correct number of units as the code for palonosetron is per 25 mcg’s. Report 10 units of J2469 (Injection, palonosetron HCl, 25 mcg). This is administered as a push, so report +96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]).

Benadryl: For Benadryl, you report 1 unit of J1200 (Injection, diphenhydramine HCl, up to 50 mg) and another unit of code +96375.

Saline: Be careful when you pick up codes for saline administration. To report the administration of saline done concurrently with other drugs, you can bill for 100 minutes. Now you need to check the medical record to confirm if your physician wrote a specific order for medically necessary hydration (reportable) or if it was simply to keep a line “open” (not reportable). The Correct Coding Initiative (CCI) manual, states, “If therapeutic fluid administration is medically necessary (e.g., correction of dehydration, prevention of nephrotoxicity) before or after transfusion or chemotherapy, it may be reported separately.” Unless you have documentation indicating the saline was ordered for a therapeutic purpose, you should consider it included in the other therapeutic infusions rather than reporting it separately or query the physician to be certain. If you do have the necessary documentation, report 1 unit of J7030 (Infusion, normal saline solution, 1000 cc) and 1 unit of +96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]) for the first hour and another unit of +96361 for the remaining 40 minutes.

Watch out: You cannot separately report the 10 cc NS. You can report the heparin used to flush the port, however only 5ml was noted and did not include the number of units contained in the 5ml. You may not the port flush itself as the irrigation of a venous access device has minimal effort associated with its provision, hence you should not report 96523 (Irrigation of implanted venous access device for drug delivery systems) in this circumstance. You would only report 96523 when no other service (e.g., evaluation and management, chemotherapy) has been provided along with the irrigation of the implanted venous access device for drug delivery.