Wiki Infusion - I'm a bit confused

[kimberlyapetro]

I'm a bit confused on how to code the concurrent infusion.

8:25-8:40 J1100 & J2405 15 min IVP
8:25-11:55 J3475 & J3480 3 hr 30 min ther inf
9:30 - 9:45 J9209 15 min chemo push
9:55-10:55 J9209 1 hr chemo inf
11:55-12:50 55 min hydration

Here is how we coded
96409
96417
96368
96375
96361

Same patient different date of service
8:20-13:20 J3480 & J3475 5hr ther inf
8:20-8:35 J2405 & J1100 15 min IVP
8:50-9:10 J9209 20 min chemo inf
9:30-10:35 J9208 1hr 5 min chemo inf
10:40-14:00 J9060 3hr 20 min chemo inf
10:50-11:05 J9209 chemo push
13:20-14:15 J3480 J3475 & J2150 55 min ther inf
14:15 all meds stopped pt taken to radiology
15:55-16:55 J3580 J3475 & J2150 1 hr ther inf
15:55-16:10 J9209 15min IVP

Here is how we coded this
96413
94717 x 2
96415 x 2
96411
96368
96366

Any suggestion would be appreciated.
Thank you

 

[plugger10]

One the first occasion you should bill 96413 for the J9209 admin. You should not bill two different routes of admin for the same drug. You always bill an initial admin for an infusion before an IV Push. The easy way to remember is Chemo drug before Therapuetic drug and Infusion before IV Push. You should also have billed 96367 and 96366 for the J3475 & J3480. You would not bill the 96368 concurrent code as you are billing for sequential Infusion for the drugs already. Your admin codes should look like this:

96413
96367
96366
96375
96361

This is for Non-facility coding.

 

[plugger10]

Your second visit is much more complicated, but should look like this:
96413
96415 x2
96417 x2
96367 x2
96368

You cannot bill 96411 as it is for a drug you already are billing an infusion.

 

[kimberlyapetro]

Thank you! On the first one I had a typo J9209 was a push and J9208 was an infusion. For this particular payer we need to bill as a physician office so since the reason for the visit is chemotherapy and the push was given first I was under the impression the push needs to be the initial code. Most payers will be as a facility. Even though from 955 to 1055 the J3475 and J3480 ran concurrent to the chemo infusion the initial and suquential should be billed not the concurrent.

I actually found that we have been coding Mesna J9209 incorrectly even though it is a J9000 code in the chemotherapy section therapeutic admin codes should be used.

Thank you.