HELP! Oncology Coding - Concurrent Chemo

DanielleKiehl

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Her is the scenario that is giving me some issues,

Day 1 - Patient got hooked up on a 5FU (Adrucil) pump on after recieving Cisplatin + PreMeds

Day 2 - While patients pump is STILL RUNNING the Cisplatin + PreMeds are being infused (concurrent with 5fu) through the SAME ACCESS (port)

Day 3 - Same as Day 2

Day 4 - Same as Day 2

Day 5 - Pump Dissconnect

Please advise on how you would code/bill Days 2-4. Do you bill the Cisplatin as 96413 (as a first drug first hour) or as 96549 (unlisted because it is being run concurrent with 5FU). Also do you bill the PreMeds as Concurrent (90768, can only value one i believe)

Thank you for your QUICK response. If you need clarification please let me know.
 

jsth10

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The 5FU is not refilled, stopped, or anything during days 2-4. it is just disconnected on day 5
Are all of the drugs running together in the pump or is the patient coming in the office for the Cistiplatin and other meds?
 
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DanielleKiehl

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i dont believe that we would charge for the pump on day 2-4, we are not filling/re filling/or disconnecting it. it is just present.
 

jsth10

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i dont believe that we would charge for the pump on day 2-4, we are not filling/re filling/or disconnecting it. it is just present.
No, you just bill the pump charge once for the first day, but are the other drugs run along with the pump or is the patient actually coming in the office for the Cistiplatin and meds?
 

DanielleKiehl

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the patient comes back to the office, and WHILE the pump is running we infuse the premeds, hydration with mg and k, and then the cisplatin. they are all going into the same access too.
 

jsth10

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the patient comes back to the office, and WHILE the pump is running we infuse the premeds, hydration with mg and k, and then the cisplatin. they are all going into the same access too.
Then yes I would do just like you suggested in your first question. Code the Cistiplatin 96413 and the meds concurrent, but remember you can only use the 90768 once per encounter. You had it right! You answered your own question :p
 

RGALVEZ

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Not knowing the pre-meds or the times for your pre-meds, I will assume that the following pre-meds and their times are as follows:
Drug Qty Infusion time Admin
Day 1: J1100 10mg 20min (eg: 8:00am-8:20am) 90767 J1200 25mg 20min (eg: 8:21am-8:41am) 90767
J2780 50mg 20min (eg: 8:21am-8:41am) 90767
J3480 40meq 1hr10min (pre-hydra 9:00-10:10) 90761
J3475 1000mg 1hr10min (pre-hydra 9:00-10:10) 90761
J9060 50mg 35min (10:05-10:40) 96413
J2150 25% in 50ml 35min (10:05-10:40)
J3480 40meq 1hr15min (post hydra 10:45-12:00) 90761
J3475 1000mg 1hr15min (post hydra 10:45-12:00) 90761
J9190 3500mg Continuous Infusion X5days 96416 59
Admins are posted as: 90767 X2, 90761 X2, 96413 X1, 96416 w/Mod 59 X1

Day 2-5 are a repeat with the exception of the 96416. That is if you give the same pre-meds, hydra and cisplatin each day. On day 6 you DC the pump. This is just an example. You are correct in that you are allowed 1 concurrency per day. I hope this helps.
 
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