Faslodex, two injections

[dtricia]

If this drug is given in two sites, should it be billed 96402, 96402.59?
Tricia D

 

[vpriya@scioms.com]

Hi Tricia,

We are billing Faslodex with admin (96402) in two separate line items as 96402 -mod (59) and in second line item 96402- mod 59,76.We are getting paid from Medicare.

Please let me know if you have questions.

Thanks,
Priya

 

[CancerCenter]

Can we not enter 96402 x 2?

 

[jrs7117]

Faslodex

I thought that if there were multiple injections of the same drug we were only to code one admin code. I have a few injectible drugs like that,

Faslodex- i use 96402 (with 2 vials injected)

Irwinia - i use 96401 (With up to 5 vials injected)

Vidaza - I use 96401 ( with up to 5 vials injected)

Can someone tell me if I am doing this wrong?

Any insight is helpful.

Julie Williams

 

[OncologyOKC]

If you are having to split the injection then you would bill 2 administration codes as long as the nurse has documented that they were each done at a separate time in a separate location. You can also see the answer in this link from HCpro.
http://www.hcpro.com/print/REV-230459-859/QA-One-injection-code-or-two.html
It would depend on carrier preference if you were to bill separate lines or just use units.

I see no reason at all that you would be using the 59 on the 1st 96402 and then a 59/76 on the second. Unless you were doing another type of chemotherapy infusion that day (which I do not see in my practice at all) we sometimes will bill the Faslodex on the same DOS as Xgeva but still the initial 96402 would not require a 59 modifier.