Oncology & Hematology Coding Alert

Question:Which of the following medications can we report as initial infusion?

·         13:00-13:20, Aloxi

·         13:20-13:40, dexamethasone sodium phosphate

·         13:40-14:10, Emend

·         14:10-16:45, doxorubicin HCL

·         16:45-18:00, normal saline solution?

New York Subscriber

Answer: You should choose an “initial” infusion code for the 14:10-16:45 doxorubicin HCL infusion. The appropriate code, representing the first hour of the infusion, is 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug). You choose the “initial” infusion code based on the primary reason for the encounter. Note that CPT^® guidelines instruct you to report only one “initial” service code when administering multiple infusions, “unless protocol requires that two separate IV sites must be used.”

There seems to be no indication of separate IV sites in the infusions described by you. Hence, you should choose a single “initial” service code. In this case the patient presents for chemotherapy, so you should review the infusions to determine which involve chemotherapy agents. The only chemotherapy infusion administration on this day as noted is the doxorubicin HCL infusion.

Check the infusion timings: Code 96413 represents the first hour of the doxorubicin HCL infusion. The infusion lasted from 14:10-16:45, which is two hours and 35 minutes. That means you need to determine how to report the additional one hour and 35 minutes. Keep in mind that CPT^® guidelines restrict the use of +96415 to infusion intervals of greater than 30 minutes beyond 1-hour increments.

You should report one unit of +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]) to represent the second hour. Because the final 35 minutes exceed the requirement for “greater than 30 minutes,” you should report a second unit of +96415 for the additional 35 minutes.