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Help with administration codes for Chemo

  1. #1
    Question Help with administration codes for Chemo
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    When billing Chemotherapy infusions, we are giving the following drugs for a patient:

    Taxol, J9265; Corboplatin, J9045; Neulasta J2505; Zometa J3487; Avastin J903: Dexamethasone J1100; Benadryl J1200; Tagament J349: and Zofran J2405.

    The Initial code is for the Taxol from 9:20AM-1:27PM

    Subsequent infusions/injections are: Corboplatin 9:20AM-1:27PM
    Avastin 1:27Pm-1:59PM
    Zometa 1:59 to 2:34 PM

    Tagament, Zofran, Decadron, and Benedryl are given at 8:55AM to 9:20AM

    Nuelasta is given sub-Q after treatment.

    We have billed as 96413 x 1, 96415 x 4, 96372 x 1, 96375 x 5, and 96366. Are these codes correct? Should 96367 be billed instead of 96366?

    Thanks for any help with this.
    Peggy Y, Green, CPC, CPMA, CPC-I, CRC
    "To love what you do and feel that it matters - how could anything be more fun?" Katharine Graham

  2. #2
    The coding that I come up with is:
    96413x1, 96415x3, 96417x1, 96367x2, 96372x1 w/ 59 mod
    The reasoning is:
    The Piggy Back of the Carbo/Taxol is a total of 4hrs & 7minutes, so there the 1 initial code (96413) and 3 additional codes (96415 x3). The Avastin infusion is a subsequent chemo admin, so that's the 96417x1. The Tagament, Zofran, Decadron, and Benedryl count as the 1st 96367 since they are all given at the same time, and the Zometa counts for the 2nd 96367. Finally the Neulasta is your 96372. Hope this helps. If not, feel free to shoot me a message. Good Luck!

  3. #3
    Thank you so much for your reply. I am still learning oncology coding.
    Peggy Y, Green, CPC, CPMA, CPC-I, CRC
    "To love what you do and feel that it matters - how could anything be more fun?" Katharine Graham

  4. #4
    Columbia, MO
    I am not seeing with the response though the carbo infusion. I am assuming this was a separate bag hung with the taxol. We always did these as the second bag as a 96368 for 1 unit so it would look like
    96415 x 3
    96417 x1 avastin
    96417 59 x 1 zometa
    were the Tagamet zofran, decadron, benadryl given as pushes? if so
    96375 59
    96375 59
    96375 59
    96372 for the neulasta
    That is how we did it in the cancer center infusion unit.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    The problem with the Carbo billing is that the Carbo was given concurrently (piggy backed) with the Taxol. It cannot be billed with a 96368 since the 96368 is for concurrent NON-CHEMO. Since the two drugs were given at the same time, you can only charge the admin for the drugs once. It would be like piggy backing the decadron and benadryl, you can only charge for one admin even though there are two drugs. Also, for the Tagament, Zofran, Decadron, and Benedryl, they would be coded as 1 96367 because they were given all at once and over a time of 25 min which qualifies them as an infusion. The Zometa is a Non-Chemo drug, so it would be billed with a 96367 as well. You always have to consider what type of drug you are coding for as well as the rules for times. =0)

  6. #6
    Columbia, MO
    Zometa is a drug which treats bone mets so it should be coded as a chemo drug. I agree the Carbo was piggy backed and is a concurrent infusion but we were told to bill it as a concurrent infusion to the intial chemo as the concurrent code does not state non chemo.
    Also any infusion less that 30 minutes I was also informed should be coded as a push, I have observed pushes that do get pushed over a 25 minute time frame. So my question was; was each of these drugs pulled into a separate syring and pushed into the line, if so they are individual pushes. I have not ever observed a nurse mixing all of these together in one bage and administered as an infusion. When I worked at the cancer center, we were required to go to the infusion unit and aobserve how the drugs were being administered to help with the coding. This is how I observed these.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Deb, you make a good point. Zometa is used to treat bone mets. Some states however do not view it as a chemo. I did not take that into consideration when I was coding it for Peggy. I can also understand where you would suggest that the Tagamet, Zofran, Decadron, and Benadryl be coded as pushes. In my office we mix the Benadryl & tagamet in the same bag, and hang it for 20ish minutes. However, according to the CPT manual, "Intravenous or intra-arterial push is defined as: (a) an injection in which the health care professional who administers the substance/drug is continuously present to administer the injection and observe the patient, or (b) an infusion of 15 minutes or less." By this definition, the 4 drugs mentioned would be considered infusions and not pushes. I suppose the coding all depends on where you are in the country (as far a the Zometa is concerned) and exactly how the nurses gave the drugs. Thanks for your side of it. I appreciate being able to learn how other clinics bill. Good luck to you Peggy on your coding!

  8. #8
    Columbia, MO
    Thank You Helen. It really does help to be able to observe how the drugs are being given, it helps get us out of that coding vaccum we can get into! So the correct answer really resides in how the drugs are given, and what purpose we use them for.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default Thanks
    Thanks to all your replies. I have a meeting with the Oncology department next week to see how they actually administer the drugs so we can get the coding correct. When it was billed orginially, Medicare (we are in GA) only paid for one of the 96375 codes billed and denied the 96374. I received several different replies to this question, here and on other Oncology forums and the majority of the replies were consistent with billing the 96417 instead of the 96374/96375 code.
    Peggy Y, Green, CPC, CPMA, CPC-I, CRC
    "To love what you do and feel that it matters - how could anything be more fun?" Katharine Graham

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