Wiki oxaliplatin infusion help!!

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lmercado21

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Need some help coding chemo infusion: Leucovorin (j0640), Fluorouracil (j9190), Oxaliplatin(j9263), calcium, magnesium, decadron,zofran..with the oxaliplatin and leucovorin concurrently being infused can you code 96549 in conjunction to this, and over 2 hours????
also, calcium and magnesium infused pre and post chemo do you use ea. seq. infusion x4?



if anyone can give some direction it would be greatly appreciated.
 
lmercado21 said:
Need some help coding chemo infusion: Leucovorin (j0640), Fluorouracil (j9190), Oxaliplatin(j9263), calcium, magnesium, decadron,zofran..with the oxaliplatin and leucovorin concurrently being infused can you code 96549 in conjunction to this, and over 2 hours????
also, calcium and magnesium infused pre and post chemo do you use ea. seq. infusion x4?



if anyone can give some direction it would be greatly appreciated.
Click to expand...

First, I have never seen the J9190 and J9263 run concurrently, it's rather dangerous to the patient. Not to say it wold never happen, I just would prefer to review the documentation. It would help significantly if you would include run times with the drugs so that we can give you a better/more accurate answer.

I have some other information at work, so if you will email my private email - I will happily share those files with you.
 
sorry if i was a lil vague in the question regarding coding.. Patient"s regimen is as follows:


Premedication:


Decadron infused 20 min.

Zofran inbfused 20 min.

Calcium & Magnesium together in same bag infused over 20 min.


Chemo Infusion as follows:


Oxaliplatin & Leucovorin are on two seperate pumps and infused simultaneously over 2 hrs.

5-FU is IVP and the patient is sent home on a pump with 5-FU infusing over 22hrs.


Post medication:

calcium and magnesium are infused in the same bag over 20min.
 
We use this all the time and code as follows:

Decadron infused 20 min. 96367

Zofran inbfused 20 min. 96367

Calcium & Magnesium together in same bag infused over 20 min. 96367


Chemo Infusion as follows:


Oxaliplatin & Leucovorin are on two seperate pumps and infused simultaneously over 2 hrs. 96413,96415, 96368 (Leucovorin)

5-FU is IVP and the patient is sent home on a pump with 5-FU infusing over 22hrs. 96409 we don't charge for the pump because homecare is facilitating this. But if you are doing the initiation of the pump then you would code 96425

calcium and magnesium are infused in the same bag over 20min. 96366
 
96366 is for extra hours and should not be used until the drug infused passes 90 minutes total infusion time. Cpt defines 96366 as " Each additional hour of infusion. Must be greater than 30 minutes.
 
Per CPT manual 2012, 96366 can be used for any second drug or subsequent infusion of the same drug/substance. becuse we give Cal/Mag twice, we can only use 96367 once therefore for the second infusion, it is appropriate to use 96366
 
traci.susong@gmail.com said:
We use this all the time and code as follows:

Decadron infused 20 min. 96367

Zofran inbfused 20 min. 96367

Calcium & Magnesium together in same bag infused over 20 min. 96367


Chemo Infusion as follows:


Oxaliplatin & Leucovorin are on two seperate pumps and infused simultaneously over 2 hrs. 96413,96415, 96368 (Leucovorin)

5-FU is IVP and the patient is sent home on a pump with 5-FU infusing over 22hrs. 96409 we don't charge for the pump because homecare is facilitating this. But if you are doing the initiation of the pump then you would code 96425

calcium and magnesium are infused in the same bag over 20min. 96366
Click to expand...

I agree with everything above. In reference to 5FU, however: as an outpatient facility, we would code/bill 96411 for the push in the office and 96416 for the pump/infusion over 22hrs. Thank you
 
I have new problem with folfox billing with one specific insurance company and I don't know where to find the documentation to support my claims. I'm hoping someone here can help me out! :)

On the second day of Folfox when the patient comes in and receives J9190 (push and pump) J0640 (2hrs) J2405 (30 min) J1100 (30 min) and has their pump refilled, we are billing admin codes 96409 96521 96367*3 96366. The payer is denying either the 96409 or the 96521 stating that only one method of administration is payable for each drug. (they don't deny the 96411 and 96416 billed for the J9190 on day 1).

I have appealed several dos and none of them have been overturned. This is a HUGE, NATIONAL insurance company with both commercial and medicare plans. So far all my denials are on Medicare Advantage patients.

Thoughts? Ideas?

Thanks!
Alanna Esler

PS I take my CPC this Saturday! Can't wait to have it over with!
 
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