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billing sequential chemo drugs 96417 multiple units

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robinpich

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I am seeking help with chemo sequential drugs.

4 chemo drugs given sequentially:

Perjeta 1500-1600 (1hr)
Taxotere 1600-1700 (1 hr)
Carboplatin 1700-1800 (1hr)
Herceptin 1800-1900 (1hr)

billed out as 96413 x1
96417 x3
and we are getting rejections on the 96417 number of units. I cannot locate an MUE edit for this code.

Co-worker says to bill 96413x1, 96417 x3-59 which would indicate sep drugs were given

another says bill 96413 x1, 96417x1, 96415x2 (under the impression 96417 can only be billed once per encounter)


help! please.............
 
The very definition of 96417 indicates that a "different substance or drug" was administered sequentially through IV infusion, so no modifier 59 would need to be added. I bill 96417 x 2 or 3 all the time and never have a problem. You are correct in the way that you have billed these.

It would be inappropriate to bill 96415 for a different substance or drug as it is specifically for each additional hour of the same substance or drug.

Are you coding 96413 and 96417 lines the same? Is it possible that the edit is not being translated accurately?
 
Thank you. We have been billing correctly then. guess it's time for an appeal on those charges. I appreciate the info.
Robin
 
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