Wiki infusion coding

caglunt

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My department is having an ongoing debate as to how to code the following scenario. We could use some guidance on this one. I have 7 coders and they all came up with a different answer. How would we properly code:

Neulasta OnPro SQ
ondanestron IV Push
dexamethasone IV Push
NaCl IV Infusion started 0845 stopped 1730
mesna IV infusion started 0930 stopped 1730
ifosfamide IV infusion started 0930 stopped 1230
 
Because I can't see the medical record, I'm assuming it was just one IV line. If there are 2 lines infusing, then the coding is completely different.

I know IV's are challenging, so I'll give this a try. :)

96372--Neulasta

96375 x2--odaneston & dexamethasone

No codes for the NaCl (I believe this was provided to help the other meds infuse, kind of like normal saline is used sometimes). Since the NaCl was infusing as the same time as the other med, I wouldn't code it.

96413 x1--Ifosfamide
96415 x3

96368 x1--Mesna
96366 x7

I'm no expert in infusion coding, any thoughts?

Sue, CPC, CCS-P
 
Mesna is not a chemo drug. It is a medication used in those taking cyclophosphamide or ifosfamide to decrease the risk of bleeding from the bladder. ***unless Mesna is a chemo-like drug??***

96549 is an unlisted code for chemo--make sure you send records listing the drug used.

Sue

Mensa
96413x1
96415 x7

ifosfamide
96549- Concurrent Chemo (very old article but still holds true(http://www.hcpro.com/HIM-68173-859/Use-unlisted-code-96549-to-report-concurrent-chemotherapy.html)

NaCL is also Concurrent (there is no ncci between 96549 & 96368)
96368

Dexameth & odan
96375 x2

neulasta- depends on the delivery
standard IM is 96372
OBI is 96377

Good luck!!
 
Last edited:
I'm aware 96549 is unlisted if you read the link I listed that is the protocol. Yes you will likely have to submit records. We bill this like 3 times a year.

Mesna qualifies as a chemo administration (this is an old link from CMS: https://downloads.cms.gov/medicare-...chments/26746_101/Article4I92ABR23DBChemo.htm) also if you look at the code in the hcpcs book it falls in the chemo range (J9209).
no matter its purpose you look at the hcpcs code for admin codes. i.e. pt receives Rituxan J9310 for RA they don't have cancer but its still a chemo drug so you use chemo admin codes. you dx with ra.
 
Thanks for the updated info! I'm always learning, that's why I love coding. :)


I'm aware 96549 is unlisted if you read the link I listed that is the protocol. Yes you will likely have to submit records. We bill this like 3 times a year.

Mesna qualifies as a chemo administration (this is an old link from CMS: https://downloads.cms.gov/medicare-...chments/26746_101/Article4I92ABR23DBChemo.htm) also if you look at the code in the hcpcs book it falls in the chemo range (J9209).
no matter its purpose you look at the hcpcs code for admin codes. i.e. pt receives Rituxan J9310 for RA they don't have cancer but its still a chemo drug so you use chemo admin codes. you dx with ra.
 
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