Wiki Infusion Administration Codes Bundling

[TB RNCPC]

I have a question about administering a chemotherapy drug and immunotherapy drug such as Avastin at the same encounter. For example, we charge a chemo drug with the admin of 96413. Then, we charge Avastin or Zometa with 96365. The 96365 denies as bundled. Is it correct to add a 59 modifier since the Avastin or Zometa is in a different class of medication from the Chemo drug?

 

[relong]

Since Avastin is a chemo drug, you would bill the 96413 for the initial hour of chemo infusion. The Zometa, as a subsequent drug would require a 96367. You can only bill one initial admin code per day. IF you are charging Avastin and another chemo drug, you need to charge a 96413 for the initial chemo infusion hour, then a 96417 for the subsequent drug's chemo infusion admission. The CPT manual breaks down all the admin codes and how they should be used. A good trick of the trade to rememeber is that chemo infusion drugs are all J9xxx. Good luck!

 

[TB RNCPC]

Thanks for the tip. Our confusion lies in the antineoplastic immunotherapy drugs, considering them a different class of drugs from the antineoplastic or chemo drugs. But, Avastin and Rituxan are J9xxx codes, where Zometa, J3487, is a different classification of drugs.