Wiki Help with 96416/cytoxan over 3 hours

[jjhill]

Pt is receiving chemo in the clinic, including cytoxan x3 hours. The pt is then sent home with portable pump x2: first pump is for cytoxan which is to run over 3 hours and the second pump is for hydration which will run for 24 hours.
The clinic time infusion is being coded with 96413/96415 as documented, but for the pump infusion at home---since the chemo itself is not running for 8+ hours, what are the best codes to use?

 

[lch]

I think it would depend on whether the pump is being initiated or refilled. The code description for initiation (96416) specifically says it has to be >8 hours, but 96521 just says refill and maintenance of portable pump.

So I would bill the 96413, 96415x2 for Cytoxan and 96521 for pump refill.

Len

 

[jjhill]

Thank you Len. That was what I was leaning toward.