Wiki Infusion coding for two drugs under one HCPCS

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mkaitz

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Two complex drugs in a combination (one HCPCS code) are each administered IV over 20 minutes, sequentially one right after the other via the same IV access point. Because it is one therapy (one HCPCS code and both drugs must be administered) is it correct to bill only 96413 (40 minute IV infusion)? Or is it appropriate to bill 96413 (first drug) and 96417-EJ (second drug)?
 
I'm a little confused by your question here - if the drugs are given sequentially, then they aren't combined/compounded, so you wouldn't use a single HCPCS for a compounded drug, as I understand it. Can you give a little more detail about the specifics of this situation?
 
mkaitz said:
Several examples of one HCPCS code used for a combination of 2 monoclonal antibodies include Q2020-Q2045. Does this clarify?
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I think you mean Q0220-Q0245? It's my understanding that those drugs are supposed to be combined and given as a single infusion so I'm not sure why you'd be seeing these given sequentially as that is contrary to the administration instructions. If for some reason that is what is being done, then I would code the administration as it was actually performed with an initial and a sequential code and there would only be one HCPCS code to bill with the two different admin codes, but I'd probably bring it to the attention of someone in the management to look into whether it's possibly being performed and/or documented incorrectly.
 
Since the sequential codes are used for each additional sequential infusion of a "different substance/drug" would the payer be looking for a different HCPCS code? Would it be correct to repeat the same HCPCS code and add modifier EJ, perhaps?
 
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