Oncology & Hematology Coding Alert

Question: We have quite a few 90766 denials stating that the "qualifying service was not identified" We submit 96413 as the initial charge code. Should we be doing something differently?

Maine Subscriber

Answer: The most likely culprit in this case is your code combination.

You can't report +90766 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour) without an "initial hour" code. CPT guidelines with 90766 specify that this code should be either 90765 (- initial, up to 1 hour) or +90767 (- additional sequential infusion, up to 1 hour). This has always been the case, but the parenthetical notes in the 2008 CPT manual make this clearer.

Don't forget: Use 90767 as the additional sequential code when you report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) as the initial code. Use 90766 when there are additional hours of non-chemo infusion, and report it only with 90765 or 90767.