IV Infusion Coding Help Needed

[ammontagano]

Leucovorin is given for 1 hour, then stopped...Fluorauacil is pushed, Leucovorin is started again.

Can you give me the sequence of codes for this scenario? I am very new to Hem/Onc coding.

Thanks all!

 

[OCD_coder]

You would typically add the times for the Leucovorin together and code the total time. You would code the J9190 as a chemo push code depending on what else if given that day.

 

[plugger10]

For J9190 you woul use 96409 as the initial Administration code. Then you would add the total time together for the Leucovorinn Infusion and bill for Therapuetic Infusion codes 96367 (If greater than 15 minutes) and add 96366 if total time is greater than 90 minutes (96366, each additional hour of infusion. Must be greater than 30 minutes.). I have been coding Oncology for almost 20 years, non-facility.

 

[RARJuni]

If you go by the coding hierarchy for drug admin, wouldn't the initial code be 96465 rather than 96409 since infusions always trump pushes? The codes would then be 96465, 96466 and 96411. Could someone let me know if this is correct?? Thanks.

 

[mjm41795]

Leucovorin is a non-chemothearpy medication, so you would refer to 96367 or 96368 depending on the the start/stop times. The above example would use a 96367 because it was a sequential infusion. If the Leucovorin was infused concurrently CPT 96368 would be used.

 

[alannae]

RARjuni:

You should review the section of the CPT manual prior to the hydration codes. I think you may misunderstand the 'hierarchy'.

5. When reported by the physician, report the "initial" code that best describes the primary reason for the encounter regardless of the order in which the infusion or injections are administered.

6. When reported by the facility, the "initial" code should be reported in the order of chemotherapy services, followed by therapeutic/prophylactic/diagnostic service, followed by hydration services, followed by infusion, followed by pushes, and finally injections.

The first step in determining which 'initial' code to bill would be to separate the types of drugs infused/pushed into chemo and non-chemo. If chemo drugs are billed, then chemo is more than likely the reason for the encounter and the initial code should be a chemo admin code (96413 or 96409 depending on infusion time).

I bill for a physician group and have never come across a case where the patient is getting chemo drugs but the chemo is not the primary reason for the encounter. Does anyone have an example of when this might occur?