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help wanted on chemotherapy

  1. Default help wanted on chemotherapy
    Exam Training Packages
    Need help with administration codes please, specifically with the calcium & magnesium given pre/post oxaliplatin.

    Dexamethasone 845-900 -- Billed 96375x1
    Palonosetron HCL 843-843 -- Billed 96375x1
    Bevacizumab 0919-0950 -- Billed 96417x1
    Magnesium Sulfate & Calcium Gluconate 0955-1010 -- Billed 96375x1
    Oxaliplatin 1012-1230 -- Billed 96413x1, 96415x1
    Leucovorin 1012-1230 -- Billed 96368x1
    Calcium Gluconate & Magnesium Sulfate 1245-1258 -- Billed 96375x1
    5FU 1258-1305 -- Billed 96411x1
    5FU 1305 pump initiation -- 96416-59x1

    We are a physician's office (if we could use the 96376, life would be much easier!!! ) Should we be combining the infusion times for the calcium/magnesium and billing a single additional sequential infusion? Or can we only bill the one additional sequential push and we have to eat the admin on the second dose?

    Any links to references is also appreciated. This problem just came to my attention and I've been researching it for about a day and a half with little to no success.


  2. Default 96376
    You can use 96376 since the magnesium, etc was given 30 min apart.

  3. Default
    Unfortunately, 96376 is for facilities only. We are a physician's office, so that rules out the simple solution. And is why we're trying to clarify the coding rule...

  4. #4
    I would bill it exactly like you did. You can bill the additional push if it was done separately. Also make sure you bill it as 2 units of 96375, don't list it separately or it will deny. The payor may ask for your drug administration for that day to prove that this was given as 2 separate pushes.
    Stephanie Thebarge, CPC, CEMC, CHONC
    Past Portland AAPC Chapter President
    Coding Compliance Specialist
    Feel free to message me with questions

  5. Default
    Thanks, SThebarge. We're checking with a consultant that we've used in the past for oncology issues but I wanted the opinion of other CPCs as well. 'Preciate it!

  6. #6
    Grand Rapids, MI
    In our office, the Mag/Calcium Gluconate are give over 2 hours so we bill it as 96367 X 1 and 96366 X 1

  7. Default
    Thanks abc1099. Thankfully, we don't run into it often but I want it to be right when we do, you know??

    I'm meeting with my manager later today to try to resolve this issue. The input from everyone has been helpful. Thanks everyone!

  8. Default
    96375, qty 2, modifier 76, is how we bill in these scenarios and we are a physicians office w/chemo infusion tx room. We have never had a denial.

  9. #9
    Overland Park Kansas
    I work for a hematology/oncology clinic where pt's see the doctor and receive outpatient tx. Only one administration is allowed per drug and the Mg Sulfate and Calcium Gluconate were mixed together so it is going to be billed as one drug. I would code as is:

    Dex --96375 x1
    Palonestron --96375 x1
    Mg Sulfate/calcium Gluconate --96367 x1 (total 28min)
    Leucovorin --96368 x1
    Oxaliplatin --96413 x1 and 96415 x1
    Bevacizumab --96417 x1
    5FU --96411
    5FU --96416
    Last edited by daisy3663; 04-28-2010 at 03:22 PM.

  10. Default
    Thanks DeniceD and daisy3663 for the additional info.

    After taking this to my manager and talking to a consultant that we work with, the official decision was to add the administration times together for the calcium/magnesium and bill an add'l sequential infusion.

    I appreciate everyone's responses

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