Oncology & Hematology Coding Alert

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Question: What is an "Ommaya reservoir" for chemo instillation, and how should I bill for it? I saw a reference for the first time recently, and after a discussion with my head oncology nurse we came up with 96450. It seems that the reimbursement is rather high in comparison to the other items in that family of codes. Am I overbilling this device? New Hampshire Subscriber   Answer: An Ommaya reservoir is a device that is surgically inserted under the scalp for direct injection of chemotherapy into the spinal fluid. When intrathecal chemotherapy is needed, an Ommaya allows drugs to be administered into the reservoir, rather than through the back during a spinal tap. Administering chemotherapy through an Ommaya is a sterile procedure, performed by a physician or trained and supervised assistant. Use 96542 (Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents) when administering chemotherapy via the Ommaya reservoir. The chemotherapy agent administered should be billed using the appropriate J code. If a significant, separately identifiable evaluation and management service is performed, the appropriate E/M service code should also be reported.

Code 96450 should be used when a spinal tap is required with chemotherapy administration. This code is defined in CPT 2002 as "Chemotherapy administration, into CNS (e.g., intrathecal), requiring and including spinal puncture." Note that the spinal tap is included with 96450. It is not appropriate to bill separately for the spinal tap. Again, the chemotherapy agent should be billed using the appropriate J code, as well as E/M services if provided.