Oncology & Hematology Coding Alert

Question: What is the appropriate use of concurrent infusion code +96368? Can this code be used for chemo drugs, or is it strictly for therapeutic or diagnostic drugs? And if it can be used for chemo drugs, should I document that the drugs were administered from two bags?

AAPC Forum Participant

Answer: You should use +96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) for therapeutic drugs infused concurrently with chemotherapy infusions.

You will first need an initial infusion code — 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) — for the chemotherapy infusion if the initial infusion and the concurrent infusion occur at the same time and in the same location. In other words, both infusions need to be on the same line using a Y-connector or a similar device to connect both bags to the same line.

If the infusions occur simultaneously using two different lines in two different locations, however, then you would bill 96413 twice using modifier 59 (Distinct procedural service) to indicate that the two services are different. And if the infusions are sequential (one after the other), then you would use 96413 along with +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]) for the second infusion.

Example: Suppose your provider gives Oxaliplatin (135mg) from 9:33-12:15 and Leucovorin calcium (632mg) (a therapeutic drug) concurrently with the Oxaliplatin from 9:33-12:15 (2 hours, 42 min) using the same line. You would document this with 96413 for the initial Oxaliplatin infusion then +96368 for the concurrent Leucovorin infusion. Additionally, as the infusion lasted an additional 1 hour and 42 minutes over the initial hour, you would use +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)) x2 for remaining time in addition to the first hour of infusion time.