Wiki Outpatient billing of Chemotherapy Infusion

[stwhitedeer]

We?re looking for help billing chemotherapy infusion in the OUTPATIENT setting. How would the following scenario be billed?

Patient received 400mg Yervoy (J9228 per 1mg) over 90 minutes. The drug was compounded in 250ml of normal saline. To administer the drug, the following supplies were used:
1 - 20G catheter needle
1 - IV start kit
1 ? IV set
1 ? IV extension set

If billing in the physician office, we would bill as follows:
J9228 X 400 (Yervoy per 1mg)
96413 X 1 (Initial hour, chemo admin)
96415 X 1 (additional hour, chemo admin)

Also, can you recommend a book or resource for billing in the outpatient setting?

THANK YOU for any assistance you can provide.

 

[OCD_coder]

In order to bill for the 96415, it must reach a 91 minute threshold. Only the 96413 is billable whether in the physician office or a facility owned infusion center.

Plus the drug.
All supplies are part of the infusion and inclusive.

CMS and most MAC carriers have infusion medical policies and great detailed information with examples.

 

[stwhitedeer]

Thanks for the information.