Wiki Billing 96416 for more than 1 drug

kathleeng

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How to bill initiation of pump for 3 drugs given for 1 pump- I know 96416 is for the initiation and can only be billed once, however I'm trying to determine what code do we use to bill a secondary drug initiated on the same pump. Guidelines state: "Do not report the initial infusion code, 96416, for subsequent infusions using the same pump. And do not use refill code 96521 for initiation.", but no further clarification is found on what code to use for subsequent infusions using the same pump on same encounter. Any feedback on this area?
 
Hi Kathleen, Are the 3 drugs part of a chemotherapy regimen?
Yes, they are all part of chemo regimen. However I found that 2 pumps were set to infuse 3 drugs in parallel for continuous IV over 24 hour period. I'm thinking we would only bill 1 admin code since all set to transfuse over same period of time... ?
 
Were these inpatient, outpatient, or take home (portable) pump? This regimen is usually not given in a portable pump due to likelihood of reaction, and 96416 is for portable/take home infusion pump only.
 
Were these inpatient, outpatient, or take home (portable) pump? This regimen is usually not given in a portable pump due to likelihood of reaction, and 96416 is for portable/take home infusion pump only.
Hi, these are initiated in office and patient sent home with the portable pump for the continuous infusion.
 
So let me understand. Usually I would see this as starting with Rituxamab, and Doxorubicin, Etoposide, and Vincristine given from the same bag and infused together continuously. Since they're all at the same time, you will only bill 99416 x1 since they're all in the same bag and infused at the same time. Admin codes are all about entry sites and times.

Is this how it's being given?
 
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