Oncology & Hematology Coding Alert

Question: A patient presents for chemotherapy treatment. The oncologist performs a 30-minute antibiotic infusion, then a 115-minute chemotherapy infusion. Which infusion does the insurer consider initial in this scenario?

Florida Subscriber

Answer: For coding purposes, payers consider the initial infusion the "main reason" the patient is seeing the oncologist. When you-re coding for multiple substances, administration order takes a back seat to the infusions- importance.

In your case, the chemotherapy is the main reason the patient is having infusion therapy. Thus, you should code the chemotherapy infusion first.

On the claim, report the following:

- 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour of chemotherapy

- +96415 (- each additional hour [list separately in addition to code for primary procedure]) for the remaining 55 minutes of chemotherapy

- +90767 (Intravenous infusion, for therapy, prophylaxis, or diagnosis; additional sequential infusion, up to one hour [list separately in addition to code for primary procedure]) for the antibiotic infusion.

Note: Do not report 96415 for less than 30 minutes of service beyond the first hour. So if the notes indicate that a patient had 75 minutes of chemotherapy, you-d only report 96413. Also, you should not report 90767 for less than 16 minutes of infusion time.

-- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.