Wiki Question on Chemo and LP

[perrinl@upstate.edu]

patient in for chemo has intial iv push 96409 and additional non chemo push 96375 and lumbar puncture 96450, can they be billed together? Outpatient setting for this instance and what changes if staus changes to inpatient?

 

[kdominick9373@gmail.com]

patient in for chemo has intial iv push 96409 and additional non chemo push 96375 and lumbar puncture 96450, can they be billed together? Outpatient setting for this instance and what changes if staus changes to inpatient?

I code for the Pediatric Oncology clinic in the hospital outpatient setting, and come across this exact situation daily. In the coding world this is the correct way to code this set of infusions & injections (96409 initial, +96375, and 96450). In the billing world though there is a CCI edit between 96375 & 96450, so just about every month this will come back to me asking for a 59 modifier on the add-on code 96375.
And this is where I have come to a dead end with coding this set of injections...because in this circumstance it is incorrect to append a modifier to the add-on code. This is because the "parent" primary procedure was not used (96374) as the initial procedure because the 96409 was the initial injection.
Sorry I can not give you an idea of what to do about the CCI edit between the two codes...can anyone else weigh in on this and maybe know the best solution?!

Thank you!

 

[ajeter]

Amy CCS,CPC

can you give additional information like what drugs are you billing. and the Initial chemo drug is it being given via IV/Port/PICC or are they administering it into the CNS?

 

[kdominick9373@gmail.com]

For the LP(96450) the patient will receive: methotrexate, cytarabine, and hydrocortizone

For the intial chemo push(96409) they are receiving vincristine and then they also receive a therapeutic push of zofran (96375). Most patients receive it through either a port or PICC.

 

[Nami]

It/lp

I get kicks all the time with the 96450 which kicks against the 96409 and the 96374.00 This is so frustrating. Putting the 59 on the 96374. What's been the outcome from your experience adding the modifier.