Wiki concurrent AND sequential??

[audioles]

I cannot find an answer or written scenario to this situation. Can someone help?

Scenario:

Avastin is given and is the initial chemo (no more than 1 hour)
Decadron and Anzemet are given CONCURRENTLY prior the chemo (30 mins)

I think the correct codes are 96413 (Avastin) and 96368 (Concurrent infusion).

I have seen scenarios like this or similar billed as 96413, 96368, and 96367. The rationale for the 96367 is that the concurrent infusion is sequential to the initial chemo.

Isn't that double dipping? Any experts out there?? I wish I had written documentation to support either but I cannot find a CPT assistant exactly like this.

 

[AuntJoyce]

Concurrent and sequential

The scenario you are describing sounds like the following: (please bear in mind that I don't have my infusion work tools here with me today and so this is off the top of my head - I have not coded infusions since July, 2009).

Also, concurrent is defined more like: one from column A and one from column B - in other words, you have to have one pre-chemo or prophylactic medication along with a chemo drug with the same start and stop times. You don't count 2 pre-chemo drugs as concurrent since you can give 2 meds in the same line at the same time from the same column...I know it's confusing but I can certainly find some reference material for you if you'd like.

Remember that you get one initial administration code and as long as chemo is administered, that will ALWAYS get the initial code.

Decadron and Anzemet (up to 1 hour) = 96366
Avastin (up to 1 hour) = 96413 - this is your initial administration since it is Chemo and is the higher dollar drug and higher dollar administration code (initial).

I hope this helps at least a little...I know it gets really confusing but then one day it becomes crystal clear...

Joyce

 

[dtricia]

Chemo with Concurrent

following 96413, one of the antiemetics has to be 96367. I agree with the choice of 96368 along with 96367