Oncology & Hematology Coding Alert

In some cases, the patient may receive an IV infusion and prolonged infusion initiation on the same day. If so, you may report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) in addition to 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump) for Medicare payers.

-Do not confuse -initial- with -initiation,-- warns Joyce Matola, billing manager for The Center for Cancer and Hematologic Disease in Cherry Hill, N.J.. -You may report only one -initial administration- per date of service. Initiation of a pump is not an initial service, and many times is subsequent to another chemotherapy service.-

Example: During the FOLFOX 4 regimen, the patient may receive Oxaliplatin on day 1 at 85 mg/m2 as a two hour infusion, concurrently with FA 200 mg/m2/day, followed by bolus 5-FU 400 mg/m2 and a 22 hour infusion of 5-FU 600 mg/m2 for two consecutive days.

Here, you would report:

- the Oxaliplatin (J9263, Injection, oxaliplation, 0.5 mg) with 96413 and +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [list separately in addition to code for primary procedure])

- the 5FU (J9190) as +96411 ( Chemotherapy administration, subcutaneous or intramuscular; intravenous technique, each additional substance/drug [list separately in addition to code for primary procedure])

- the concurrent leucovorin with +90768 (Intravenous infusion, for therapy, prophylaxis or diagnosis [specify substance or drug]; concurrent infusion [list separately in addition to code for primary procedure])

- pump initiation with 96416.