Oncology & Hematology Coding Alert

Question: If the physician administers chemotherapy into an Ommaya reservoir in the hospital setting, may we report a chemotherapy administration code for the physician? Georgia Subscriber

Answer: Yes. You should report 96542 (Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents) for the physician's administration of the chemotherapy agent.

You typically don't report chemotherapy administration codes for the physician in the hospital setting, in part because the hospital employs the nurses who perform the actual administration.

CPT guidelines for chemotherapy administration indicates the following codes "are not intended to be reported by the physician in the facility setting":

• 96401-96402, subcutaneous or intramuscular chemotherapy administration
• 96409-96425, intravenous or intra-arterial chemotherapy administration
• 96521-96522, pump refilling and maintenance
• 96523, implanted venous access device irrigation.

Code 96542 is not included in the above list. Administration of the chemotherapy into an Ommaya reservoir requires specialized training. If the physician administers the chemotherapy agent, you should report 96542 for that service on the physician's claim.