Question I am doing Chemo coding and have three 96417, i am a little confused, should this be only coded once as stated in CPT ?

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How do i code 96417 in Chemo coding, If I have three different infusions ? Do not understand the part about using it only once then using 96415.


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The starting rule with chemo/infusion billing is that you use only 1 code noted as "initial" per visit and the additional drug infusions are coded as sequential.
If you are new to chemo coding, you should do some research. It can get tricky knowing when to code push vs infusion; knowing which are chemo meds vs other meds; knowing exactly how much additional time is another hour. Read through the posts in the hem/onc forum as well as coding articles by oncology focused organizations.

For example, in your above question, if it was 2 chemo meds, each 1 hour, and a 15 minute Zofran infusion, that would be coded
96413 initial chemo, up to 1 hour
96417 sequential chemo, 1 hour
96375 sequential IV push

If you have 3 different chemo med infusions, each 1 hour, that would be coded
96413 initial chemo, up to 1 hour
96417 x2 sequential chemo, 1 hour each

If it was 3 chemo meds, 1 for 2 hours, 1 for 1 hour, 1 for 45 minutes
96413 initial chemo, up to 1 hour
96415 additional hour of same med
96417 x 2 for the 2nd med 1 hour and 3rd med 45 minutes

And don't forget all your J codes with appropriate quantity if you are providing the medications!
Good luck!
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