Oncology & Hematology Coding Alert

Nonchemo injections have their own code set When checking a procedure report, you should know what key terms distinguish a chemotherapy injection from an infusion. Also, when the nurse performs a chemo injection and therapeutic injection in the same session, you'll need to know how many codes to report.

In the last issue of Oncology Coding Alert, we looked at several chemotherapy delivery methods in "Chemotherapy Administration: Your Top-3 Coding Problems Solved."

This month, we continue our look at chemo administration with some tips on what to report (and what not to report) when coding for chemo injection sessions. Chemo Injection Defined "An injection is a forceful, direct introduction of a drug or other fluid into the patient's bloodstream or body tissues," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga. If that "drug or fluid" is a chemotherapy agent, CPT has a code for the situation.  When to Use 96400 When a nurse (or physician, depending on the situation) injects chemotherapy drugs into a patient either subcutaneously or intramuscularly, you should report the procedure with 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia). Also don't forget to report the appropriate J code for the chemotherapy drug(s) on your claim.

Example: A patient with breast cancer reports to the office for treatment. The physician subcutaneously delivers 40 milligrams of the anti-cancer drug Taxotere. On the claim, you should:

report 96400 for the injection.

report J9170 (Docetaxel, 20 mg) x 2 for the drug supply.
 
Another tip: If a nurse or physician administers multiple drugs during a single injection, report 96400 only once, but include the HCPCS codes for each drug delivered.

Don't Confuse Injection With Infusion Problem: Given that their definitions are somewhat similar, you could easily confuse chemotherapy injections and infusions (CPT codes 96410-96414), especially if you're reading an especially large or messy procedure note or flow chart. However, if you want your coding to be accurate, you must remember to keep the two definitions straight.

"Injections are very similar to infusions in the sense that both techniques administer fluids and medications to the patient intravenously," according to the HCPCS Coding Clinic, Fourth Quarter 2001. But that is more or less where the similarities end. Injections and infusions may be similar procedures, but they're not identical - and code confusion can send your claim to Denial Land.

Coder's definition: "A chemo injection is the drug being injected directly into the skin. Chemo infusion is the drug being infused directly into the vein and/or port intravenously," says Kelly Reibman, CPC, billing manager at the office of Mariette Austin, PhD, MD, in Easton, Pa.

Injection or Infusion? Delivery Method Often Tells Hot tip: If you're stuck on [...]