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WonderCoder

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I am new to chemo coding and would love some help with this scenario.

pt recieved:

Zofran start 10:12 end 10:38
Carboplatin start 11:00 end 12:12
Etoposide start 12:25 end 13:56
Compazine start 13:25 end 13:37

What would be appropriate to bill for the compazine push adm?

Thank you
 
Compazine IVP

Based on your scenario it would be appropriate to code compazine as 96375. Hope this information helps and Good Luck!
 
Wondercoder~
According to CPT guidelines, the 96375 is to be used fora "secondary or subsequent service." The Compazine was pushed concurrently with the Etoposide, therefore you cannot charge for the IVP of compazine. Hopefully this clarification didn't come too late. Best of luck!
 
hnroberts said:
Wondercoder~
According to CPT guidelines, the 96375 is to be used fora "secondary or subsequent service." The Compazine was pushed concurrently with the Etoposide, therefore you cannot charge for the IVP of compazine. Hopefully this clarification didn't come too late. Best of luck!
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Hmmmmm. I think they were referring to secondary to the initial not secondary meaning other services are no longer running. The difference between initial and secondary with infusions is vein access. If a vein is accessed only once then you can have only one initial code all others must be subsequent. So an infusion can be running and secondary to that access but while those fluids are infusion a push can be administered. Therefore the compazine can be coded with the 96375.
 
RE: Mitchellde's Response

mitchellde said:
Hmmmmm. I think they were referring to secondary to the initial not secondary meaning other services are no longer running. The difference between initial and secondary with infusions is vein access. If a vein is accessed only once then you can have only one initial code all others must be subsequent. So an infusion can be running and secondary to that access but while those fluids are infusion a push can be administered. Therefore the compazine can be coded with the 96375.
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Debra -
I'm not certain what your point is in regards to defining the difference between initial and secondary infusions and venous access. According to the CPT guidelines "Report 96375 to identify intravenous push of a new substance/drug if provided as a secondary or subsequent service after a different initial service is administered through the same IV access." The compazine in question was given while the subsequent chemotheraphy was running. When administering chemotherapy, it's not normal practice to have multiple venous accesses open, therefore your argument of "secondary infusions" is moot. If you don't have chemotherapy coding and billing experience I could understand how this mistake could be made, however, don't chide those of us who do have the experience and the credentials to back it up.
 
hnroberts said:
Debra -
I'm not certain what your point is in regards to defining the difference between initial and secondary infusions and venous access. According to the CPT guidelines "Report 96375 to identify intravenous push of a new substance/drug if provided as a secondary or subsequent service after a different initial service is administered through the same IV access." The compazine in question was given while the subsequent chemotheraphy was running. When administering chemotherapy, it's not normal practice to have multiple venous accesses open, therefore your argument of "secondary infusions" is moot. If you don't have chemotherapy coding and billing experience I could understand how this mistake could be made, however, don't chide those of us who do have the experience and the credentials to back it up.
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OK, I was not "chiding" anyone nor did I make a mistake. I have several years of experience to back it up and do not wish to get into any argument over who's is bigger. I am pointing out the initial refers to the initial access of the vein. Only one initial service can be bill per vein access. after that every else is subsequent or concurrent. Yes the compazine can be billed as a subsequent service. Using the same quote per CPT you use the 96375 after a different initial service, it does not mean after the infusion is completed it mean after the initial access to push a drug via the same access must be billed as a sequential service. Most pushes are administered while other fluids are infusing. This is why you cannot bill initial IV push. Pardon while I disagree with you respectfully.
 
WonderCoder said:
I am new to chemo coding and would love some help with this scenario......
What would be appropriate to bill for the compazine push adm?

Thank you
Click to expand...

Ultimately, we all may interpret the CPT guidelines differently. The claim will only get paid if you follow the guidelines as set forth by your payer and their interpretation of the CPT guidelines. Check the LCDs for your area and for your payers. Good luck in the future!
 
I do not think it is a difference in Payer interpretation, The AMA is pretty clear in how this is to be done they use to (and may still) have a very good complete instruction on how to code infusions on the AMA website. It is not abiguous at all.
 
I am going to add my experience here so that anyone reading this thread will have additional information to learn from. I am agreeing with Helen based on my experience from reading audit reports on our Oncology clinic.

We have been told to view infusion time just like a time line and if there is overlap with infusions (pushes or infusions) then you cannot bill for both. They are considered bundled. We cannot double dip the time for the work by infusion. There must be administration into two different holes into the patient to be able to bill separately.

The compazine push time runs concurrently with the chemo and it cannot be billed. This is not an infusion by definition so a 96368 is not appropriate. It is by definition a push as it runs less than 15 minutes.

The only drug that comes to mind that you can bill as concurrent is Leucovorin. Because it is usually into a separate line from the chemo drug.

In addition:
We also recieved several denials from insurance companies after submitting our records and they stated that the push within the start/stop time of the infusion into the same line/hole for the patient is not allowed. This would be the same if two drugs were given as an infusion. Only code for one infusion.

I hope this helps a little more.
 
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