Oncology & Hematology Coding Alert

Question: A patient presents for chemotherapy. In the same bag, Decadron phosphate and Zofran IV run from 1:05 to 1:20. There’s an IV infusion of levoleucovorin from 1:20 to 3:25, and then there’s a 5FU bolus IVP from 3:25-3:30. How should I code this?

Oklahoma Subscriber

Answer: You should report both the administration and IV drug supply. For the final claim, you’ll need to review the amounts administered so you can calculate the number of units for each HCPCS drug code.

5FU: Fluorouracil, also called 5FU, is a chemotherapeutic agent, and it is the primary reason for the infusion service. In this case, it is administered as an intravenous push (IVP). To report the administration, use 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug). Assign J9190 (Injection, fluorouracil, 500 mg) for the 5FU supply.

Levoleucovorin: Next, determine the administration and drug J code for the levoleucovorin infusion. Documentation shows it ran for two hours and five minutes. To be sure you choose the appropriate administration code, you must avoid the common misconception that levoleucovirin is a chemotherapeutic agent. So for the first hour, you should report +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]). You also will need an additional code for the second hour: +96366 (… each additional hour [List separately in addition to code for primary procedure]).

The infusion runs five minutes longer than two hours, but you should not report a separate admin code for those additional five minutes. CPT® guidelines instruct you to report an additional hour code only if infusion time reaches 31 minutes past the previous hour.

For the supply of levoleucovorin, report J0641 (Injection, levoleucovorin calcium, 0.5 mg). Levoleucovorin is sold under the brand name Fusilev.

Decadron and Zofran: Decadron is a glucocorticoid, and Zofran is used to prevent nausea and vomiting. Because the two are mixed in the same bag, you should report a single code to represent the administration of both. An infusion that lasts 15 minutes or less is defined as a push by CPT®, so use push code +96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]).

For the Decadron supply, report J1100 (Injection, dexamethasone sodium phosphate, 1mg). Finally, assign J2405 (Injection, ondansetron hydrochloride, per 1 mg) for the Zofran.