Oncology & Hematology Coding Alert

Question: A patient of chronic lymphocytic leukemia received rituximab 679 mg through IV route. The infusion began at 11:20 am and lasted till 4:40 pm. During this span, at 12:40, the patient complained of pain and chills, and the infusion was stopped. The infusion was re-initiated at 1:55 pm. How can we bill for the rituximab infusion?

Alaska Subscriber

Answer: You should precisely calculate the timing of infusion. You do not bill for the duration of discontinuation of rituximab infusion. Chemotherapy was stopped at 12:40 and resumed at 1:55 pm (1 hour, 15 min). You will need to deduct this time from the total time of 5 hours and 20 minutes. Therefore, you would bill for a total time of 4 hours and 5 minutes.

Submit code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour of chemotherapy infusion. Also submit 3 units of code 96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]). You do not report the 5 minutes as code 96415 is used to report infusions for intervals greater than 30 minutes beyond one hour increments.

What is rituximab? Rituximab is an anti-CD20 monoclonal antibody, produced by recombinant DNA in Chinese Hamster ovaries, and is used in the treatment of lymphoma.

Submit J9310 for rituximab: Code J9310 (Injection, rituximab, 100 mg) reports 100 mg of rituximab. Your physician administers 679 mg of rituximab. You submit 7 units of J9310 (rounding up to the next unit). If you submit 6 units of J9310, you would not be reimbursed for 79 mg of the medication given. For additional information about rounding HCPCS codes reported, see the Medicare Claims Processing Manual, Chapter 17, Section 10.