Oncology & Hematology Coding Alert

Question:

Pennsylvania Subscriber

As a starting point, assuming chemotherapy is the primary reason for the encounter, you should report the administration of chemotherapy drugs Avastin and Gemzar using 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for one and +96417 (... each additional sequential infusion [different substance/drug], up to 1 hour [List separately in addition to code for primary procedure]) for the other.

Reason: CPT guidelines instruct that when the physician reports infusion codes, "the 'initial' code that best describes the key or primary reason for the encounter should be reported irrespective of the order in which the infusions or injections occur."

You should report the drugs in addition to the administration. For Avastin, report J9035 (Injection, bevacizumab, 10 mg), and use J9201 (Injection, gemcitabine hydrochloride, 200 mg) for the Gemzar.

Because the Kytril (antiemetic) and Decadron (corticosteroid) were mixed in the same bag, you should report a single unit of a single code to report the administration of both: +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, up to 1 hour [List separately in addition to code for primary procedure]).

Again, you should report the drugs in addition to the admin. Use J1626 (Injection, granisetron hydrochloride, 100 mcg) for Kytril and J1100 (Injection, dexamethasone sodium phosphate, 1 mg) for Decadron.

Your diagnosis should be 162.3 (Malignant neoplasm of trachea, bronchus, and lung; upper lobe, bronchus or lung), remembering to first list V58.11 (Encounter for antineoplastic chemotherapy) if chemotherapy was the sole reason for the visit.

Because you have documentation of dehydration (276.51, Dehydration), you may report this code, as well. Watch for: Many payers follow Medicare's lead in not paying for hydration provided concurrently with other infusions, so you should not report the saline or administration separately to those payers. (See "Nix Reporting NS Concurrent With Chemo" on page 54 for a more detailed explanation of where to find this rule.) The patient did have 15 minutes of hydration alone, but guidelines listed under 96360 (Intravenous infusion, hydration ...) state "do not report intravenous infusion for hydration of 30 minutes or less."