Oncology & Hematology Coding Alert

Question: My practice is debating whether 61026, 96450, or 96542 is the most appropriate code for chemotherapy administration through a scalp Ommaya reservoir to treat a patient for brain cancer secondary to lung cancer. Which is correct?

New Jersey Subscriber

Answer: You should report 96542 (Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents) for chemotherapy administration through an Ommaya reservoir located in the scalp.

Heres why: A surgeon places the Ommaya reservoirs catheter into a ventricle, a brain cavity filled with cerebral spinal fluid and continuous with the central nervous system. Code 96542s descriptor specifies intraventricular chemotherapy via the reservoir.

Code 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture) also refers to the central nervous system (CNS), but the code is more appropriate for a spinal infusion involving spinal puncture at the time of administration.

Youre unlikely to report 61026 (Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment) for a medical oncologist because it is more common for neurological or intracranial surgery.

ICD-9: Be sure you include the appropriate ICD-9 codes for the patient:

" V58.11 -- Encounter for antineoplastic chemotherapy

" 198.3 --  Secondary malignant neoplasm of other specified sites; brain and spinal cord

" 162.x -- Malignant neoplasm of trachea, bronchus, and lung (choose appropriate code based on documented location).