Help_ chemotherapy infusion

maitri1970

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I do billing for oncology and I have always billed infusions as follows:( example )
(2009 new codes)
96413
drug
96365 mod 59 ( same IV site)

I have attended a CPC boot camp to take my exam and my instructor said this is appropriate coding ( I have been doing this way for years). I have now become very confused because some sources are telling me I can not use 96365 with the 96413 because they are both initial codes. ( pt is getting both pre meds and anti neoplastic drug through same IV site)

Can anyone shed light on what is correct?

Thank you soo much !
Treena
 

Peter Pan

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Hope this helps!

Hi,

I did some reseach in reference to your wonder about the correct way to code these services. I found this website with some great information. This is what they provided:

96413 Chemotherapy administration, intravenous infusion technique, up to one hour, single or initial substance/drug
(Report 90761 to identify hydration if administered as a secondary or subsequent service in association with 96413 through the same IV access)
(Report 90766, 90767 to identify therapeutic, prophylactic, or diagnostic drug
infusion or injection, if administered as a secondary or subsequent service in
association with 96413 through the same IV access)
Found at: http://www.emedny.org/ProviderManuals/Physician/PDFS/Physician Procedure Codes Sect3.pdf (On page 19)

Since this is your line of work, you are probably more familiar with these codes and understanding their usage. However, as a new coder I must say that your question has caused me to research the fine details of chemotherapy. This quest has helped me greatly-thanks!:)
 

maitri1970

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Thank you so much for your reply. Part of the issue is that I have gotten mixed messages. I have researched various sources and it seems that I kept getting conflicting information.( speaking to CPC coders vs written documentation)
Yes, I have tried to bill according to what I have found. ie, billing 96413 along with a 96366, and Medicare denied it stating it needs a preceding code of 96365 which is conflicting..:eek:
Anyways thank you for your time and if I get a straight answer, I will let you know ..
And yes, oncology is challenging but I do enjoy a good challenge :cool:
 

tracyhelget

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Per CPC, page 435 of the 2009 Professional Edition "When administering multiple infusions, injections or combinations, only one 'initial' service code should be reported, unless protocol requires that two separate IV sites must be used."

You should be reporting 96413 as your initial and 96366 as your secondary. Some carriers will pay the way you are billing it, but that doesn't make it right.

Tracy Helget, CPC
 

maitri1970

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Thank you for your reply :)
Part of the problem is that I have attended a CPC boot camp and the instructor told me it was fine to bill the two intial codes...It just confused me is all . I appreciate your time :)
 

tracyhelget

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I prefer to use the source that I can reproduce, and that is instruction from the CPTmanual. Or CPT Assistant. And I always code with the thought of "could I support this if we were audited or I was called into a court." CPT will support my actions without question.

Tracy
 

markwruff

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Thank you for your reply :)
Part of the problem is that I have attended a CPC boot camp and the instructor told me it was fine to bill the two intial codes...It just confused me is all . I appreciate your time :)
Maitri

you should be using 96367, 96366 is if your using the same drug for additional hours. I bill chemo on a regular, if you have any questions feel free to PM me.
 
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