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Oncology & Hematology Coding Alert

READER QUESTIONS:

Code Chemo? Choose 96542, Not 61026

Published on Mon Oct 10, 2005

Question: May I report 61026 for administration of chemotherapy following an Ommaya tap?


Indiana Subscriber


Answer: In short--no. You should report 96542 (Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents) instead of 61026 (Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment).

Reason: The fees for codes 96400-96542 include line access along with chemotherapy agent prep, drug dilution, infusion supplies, and vascular device or reservoir maintenance, according to AdminaStar Federal in Indiana.

If you perform an Ommaya tap with aspiration of fluid only, report 61020 (Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection).

Code 61026 is more likely to be used for neurological or intracranial surgery, such as muscle nerve biopsy, hydrocephalus-related procedures, or intracranial injuries.
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