Oncology & Hematology Coding Alert

Question: My practice is debating whether 61026, 96450, or 96542 is the most appropriate code for chemotherapy administration through a scalp Ommaya reservoir to treat a patient for brain cancer secondary to lung cancer. Which is correct? New Jersey Subscriber Answer: You should report 96542 (Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents) for chemotherapy administration through an Ommaya reservoir located in the scalp. Heres why: A surgeon places the Ommaya reservoirs catheter into a ventricle, a brain cavity filled with cerebral spinal fluid and continuous with the central nervous system. Code 96542s descriptor specifies intraventricular chemotherapy via the reservoir. Code 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture) also refers to the central nervous system (CNS), but the code is more appropriate for a spinal infusion involving spinal puncture at the time of administration. Youre unlikely to report 61026 (Ventricular puncture [...]