Oncology & Hematology Coding Alert

Don't own the pump? That doesn't mean you have to miss out on 96425 reimbursement Liver cancer cases are on the rise, so you need to be equipped to code the intra-arterial (IA) infusions doctors may order as treatment. Even if you-ve honed your IV infusion coding skills to be razor sharp, you can't afford to miss these expert IA coding tips, revealing where IA and IV coding rules are the same -- and where they differ. The codes: CPT 2007 lists four codes under "Intra-Arterial Chemotherapy": - 96420 -- Chemotherapy administration, intra-arterial; push technique - 96422 -- - infusion technique, up to one hour - +96423 -- - infusion technique, each additional hour - 96425 -- - infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable implantable pump. Zoom in on ICD-9 Metastasis Rule to Prevent Denials Payers are most likely to cover IA chemo, which is not as common as IV chemo, for liver cancer and colon cancer metastatic to the liver. You should report primary liver cancer with 155.0 (Malignant neoplasm of liver and intrahepatic bile ducts; liver, primary), says Linda Templeton, CPC, CPC-H, CCS-P, an independent coding consultant based in Rossford, Ohio. The most common type of primary liver cancer is hepatocellular carcinoma, Templeton notes. Other types include cholangiocarcinoma, hepatoblastoma and angiosarcoma, she says. ICD-9 classifies colon cancer metastatic to the liver under 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary), Templeton says. According to official ICD-9 guidelines, "When a patient is admitted because of a primary neoplasm with metastasis, and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present," Templeton says. Translation: Report secondary neoplasm code 197.7 when a patient with colon cancer metastatic to the liver presents for secondary liver neoplasm treatment only. 96420: Apply -Push- Definition to IV and IA Term: CPT guidelines indicate that the same definition of "push" applies to both IV and IA administration, Templeton points out: a) "an injection in which the healthcare professional who administers the substance/drug is continuously present to administer the injection and observe the patient" OR b) "an infusion of 15 minutes or less." When your provider documents an IA chemotherapy push, you should report 96420. Example A: A nurse administers a 25-minute IA chemotherapy injection. She is present the entire time and observes the patient throughout the injection time. You should report 96420. Example B: A nurse administers a five-minute IA chemotherapy infusion. You should report 96420. 96422/96423: Minute 31 Is the Coding Key When the patient receives an IA chemotherapy infusion lasting more than 15 [...]