Coding Help - I am helping the coding accuracy in EMR

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vguyton

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I am helping the coding accuracy in EMR usage and wanted to verify since we are having difficulity agreeing on the correct administration codes. Could someone please look over the following examples and let me know from your experience what the correct codes would be? I greatly appreciate anyone and everyones help!

Example 1
Velcade 13:17-13:18 96409
Decadron 13:00 - 13:02 96375
Normal Saline 12:30 - 13:24 Would this be considered 96361?

Example 2
Calcium hydraton 13:00 - 13:30
Magnesium hydration 13:30 - 15:16

Example 3
Oxaliplatin 12:00-14:00
Cisplatin 12:00-14:00
These drugs are in separate bags.
 
Example 1
96361 would be correct. Saline is used for hydration (if I remember correctly, it is to protect veins - don't quote me on this though since I am not clinical and don't have my notebook with clinical info handy). From the billing standpoint, Velcade and Cisplatin are two drugs that we report hydration codes with.

Example 2
I would code 96365 for Calcium (first hour infusion 16min or more) and 96367+96366 (second hour = 60min plus 31 min or more) for Magnesium. (1.Saline is used for mixing and is not billable. 2. Even though it says "hydration" cannot use 96360 and 96361 according to CPT guidelines).

Example 3
96413+96415 for Oxaliplatin
96459 for Cisplatin

I've never seen concurrent administration of chemotherapy agents done in our practice so I don't know how well and if 96459 is reimbursed. However, in theory (and per November 2005 CPT Assistant) if chemo drugs are given concurrently, we ought to report 96459 (unlisted chemotherapy procedure).



Best regards,

Lioubov Petrova, CPC
 
I would have to disagree with the 96459 because the code is not listed in my 2010 CPT manual so I'm not sure if its a valid code.

If you have two chemo's you would code an initial and a sequential meds.

so I would code as 96413, 96415 for the Oxaliplatin and 96417 and 96415-59 for the Cisplatin

Hope this helps

Joyce
 
JMGEYER said:
I would have to disagree with the 96459 because the code is not listed in my 2010 CPT manual so I'm not sure if its a valid code.

If you have two chemo's you would code an initial and a sequential meds.

so I would code as 96413, 96415 for the Oxaliplatin and 96417 and 96415-59 for the Cisplatin

Hope this helps

Joyce
Click to expand...

I think they meant 96549 as the unlisted for concurrent chemo infusion. Yay for typos.

The Oxaliplatin and Cisplatin run the same exact times, so one would not be sequential to the other; one is concurrent to the other while in separate bags and being infused via Y line, not mixed.
 
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