Oncology & Hematology Coding Alert

 Question: What CPT infusion codes should I report for a 150-minute Rituximab infusion? How many units should I report?

Maine Subscriber

Answer: You should report one unit of 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first 60 minutes of the Rituximab infusion.
 
For the remaining 90 minutes, report one unit of +96415 (- each additional hour).
 
Why: CPT's instruction for 96415 says to report the code for infusion intervals of -greater than 30 minutes beyond 1-hour increments.- The remaining 90 minutes from the example break down to one hour (which you report) and 30 minutes. Those 30 minutes do not meet the -greater than 30 minutes beyond 1- hour increments- requirement to code an additional hour. Result: You have one 60-minute charge (96415) because you only have 30 minutes beyond a one-hour increment into the next hour.
 
If the provider had instead performed and documented a 151-minute infusion, you would report two units of 96415 in addition to the one unit of 96413.
 
Don't forget: CPT 2007 removed the phrase -1 to 8 hours- from 96415.