Oncology & Hematology Coding Alert

Question: We send pumps home with some of our patients and need to know how to code for the infusion. Can we report 96410 and 96412 for the first eight hours and then 96414 for the remainder?

New York Subscriber

Answer: If your oncologist initiates a chemotherapy infusion in the office and then sends that patient home with the pump, you can report 96414 (Chemotherapy administration, intravenous; infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump). But carriers will not pay you separately for the disconnection from the pump, which they consider included in 96414.

You should report 96414 and 96425 (Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion [more than 8 hours], requiring the use of a portable or implantable pump) for a prolonged infusion (at least eight hours) of antineoplastic medication.

Make sure the oncologist uses a pump and administers the drug at a controlled rate to avoid toxicity. Also, you cannot use another means of administration.

Insurers will reimburse for refilling and maintenance of a portable pump (96520, Refilling and maintenance of portable pump) or an implantable pump or reservoir (96530, Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]) once per episode of care.    But you should not expect payment for 96520 and 96530 in addition to chemotherapy administration on the same date of service.

Code 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour) is mutually exclusive to 96414, but CMS and other carriers allow you to use a modifier, such as -59 (Distinct procedural service), to differentiate between the services provided.