Urology Coding Alert

Question: I need advice regarding how to bill for patients who have a central venous catheter for Provenge infusions to treat metastatic prostate cancer. I’m billing Q2043 with 96413 for the infusion. The nursing staff has explained the lengthy process of pre- and post-infusion care of the central line, which makes me wonder if there are any additional codes I should be billing. Or, do I include that time in the infusion code by billing 96415 (for each additional hour) in addition to 96413?

South Carolina Subscriber

Answer: HCPCS (Healthcare Common Procedure Coding System) code Q2043 (Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion) includes Provenge, and all preparatory procedures such as collection of cells from the patient, flushing and maintaining open IV lines, preparation of all materials, and their transportation. In addition to Q2043, report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the IV infusion up to one hour.

For the extra work involved that you mention (i.e., pre- and post-infusion hydration), report the “add on’ code 96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]). For each additional hour of transfusion after 30 minutes beyond the one hour initial increment, include a second “add on” code, 96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]). CPT^® does not include any other codes with reference to the correct reporting of Provenge infusion.