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Thread: IV infusions

  1. #11
    Join Date
    Apr 2007


    AAPC: Back to School
    Do you know where i can get a list of chemo drugs so i know which one's to bill for ?

  2. #12


    Different carriers allow different classifications on Leucovorin. So you will have to look at your carrier to see if it will allow Leucovorin as chemo--mine does.

  3. #13
    Join Date
    Apr 2007
    Columbia, MO


    Quote Originally Posted by cpccoder2008 View Post
    We are billing for the Oncologist only. This is a brand new service to our company so we aren't too familiar with it's coding so i really don't know what drugs are chemo and which one's aren't. I get a list of the chemo drugs used and a charge sheet that looks like a anesthia sheet starting the start and stop time and they way it was administered. This patient had an Oxaliplatin and Leucovorin infusion with a fluorouracil push and sent home with a CADD pump with fluorouracil. Does that make sense ?? This is my second chemo i am trying to code and the first one had a fluorouracil and Leucovorin push. I just thought they were both chemo drugs because on my charge ticket it is listed under chemo drugs, not with the pre-medication drugs or other drugs used. We don't bill for nurse's so we can't bill the 99211, we are only billing the admit of the drugs for the physician. I was told i couldn't bill for anything else because we don't own the drugs or the nurse's. I am sooo very confused !!!
    So you are billing for the physician, who has ordered this service to be performed in an outpatient facility? Is this correct? or inpatient facility? Then is your physician actually starting the IV, and staying with the patient and charting the start times stop times and patient condition thru the entire process? Because if not then your physician cannot bill the infusion charges, those go to the facility. And as far as which drugs are chemo, look in your PDR.

    Debra A. Mitchell, MSPH, CPC-H

  4. #14
    Join Date
    Apr 2007

    Default infusion coding

    when billing for two seperate sequential drugs is the correct coding

    96367 x 2, or 96367 x 1, 96367-59 x 1 ?

    there are some discrepencies in our office.

    thanks, nikki

  5. #15


    I would not use the modifier -59, it does not appear to be necessary. Below the code it indicates...

    "Report 96367 only once per sequential infusion of the same infusate"

    each reporting of 96367 appears to indicate a different drug

    Hope this helps,
    Last edited by ciphermed; 11-20-2009 at 09:51 AM.
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

  6. #16


    I realize this is a year old, but in case anyone is using this thread for reference:

    Oxaliplatin- 96413, 96415 (1 hr, 31 min til 2 hr, 30 min)
    Leuc- 96368 (not chemo, but basically always concurrent w/ oxaliplatin and under therapeutic/diag)
    IV push Fluoro- 96411
    5FU pump initiate- 96416

    99211 when disconnecting 5FU, just as someone else said, unless more services qualify a higher CPT.

  7. #17


    I was told the 96521 was to be used because it includes disconnect. Is that not correct? But then I read the heading "Codes 96521-96523 may be reported when these devices are used for therapeutic drugs other than chemotherapy". That statment makes me think the 96521 can't be used when adminstering chemo, but under 96416 it states "For refilling and maintenance of a portable pump or implantable infusion pump or reservoir for drug delivery, see 96521-96523)

    Is that why you say to use the 99211 when disconnecting the pump?

  8. #18
    Join Date
    Apr 2007
    Grand Rapids, MI


    Leucovorin when given concurrently with Oxaliplatin is billed as 96368 x 1. Time does not matter with that code - the most you can bill is 1. Of course, the Oxaliplatin is billed 96413 x 1 and any additional hours are billed 96415.

  9. #19
    Join Date
    Apr 2007
    Bettendorf, IA


    As a quick tip... the infusible chemo drugs are J9***, if you ever see those J9*** codes you'll know they are chemo. When the patient comes in to have their pump d/c'd you can bill a 96521. You need to really study the drugs to become familiar with what's chemo and what's non-chemo. Good luck!

  10. #20


    The chemo drugs start with J9xxx.

    This is how you would code for the FOLFOX regimen: 96413, 96415 for Oxaliplatin, 96368 for Leucovorin (J0640 - non chemo drug) running concurrently and always in a separate bag (please note that once in a while you might come across the scenario where Oxaliplatin will be given for 1hr 31min and they would let Leucovorin run for an additional 30+ minutes (same start time). You still would bill 96368 times one unit (no 96368 x 2 or 96368+96366). 96411 for 5FU (push) and 96416 with 59 modifier for 5FU that goes into pt's pump. The place of service on 5FU that goes into the pump should be 12 (to reflect that the drug is given at home - i forgot how it is worded exactly). However, you might want to check with the payers - in our area we have one that insists on not changing the place of service (their logic is that the drug was initiated in the office, therefore, place of service - 11 - should reflect that) so we oblige.

    Best regards

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