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Chemo administration

  1. #1
    Default Chemo administration
    Medical Coding Books
    A clinical nursing supervisor explained that a patient received a chemo drug ordered to be given over an hour (96413), but she documented that the administration was stopped after 10 minutes because the patient had an adverse reaction. The reaction was documented, so she believes it is appropriate to code 96413 as ordered.

    I am questioning this because actual administration time was only 10 minutes
    (96409), yet I am told I cannot bill this as a "push".

    Any words of wisdom and experience will be helpful. Thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    you cannot bill for an hour of "intended" administration, only that which was completed. Per AHIMA citing a CMS 2007 transmittal:
    Injection versus Infusion

    Length of time, calculated by the start and stop times, determines whether a procedure is coded as an infusion or injection. To ensure accurate coding and billing, providers must understand the start and stop documentation requirement. Any infusion less than 15 minutes should be coded as an intravenous push injection.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Just as I thought. Thank you. I billed this as 96409.

    In cases like this where the physician evaluated the patient (99214-25) and the nurse had to spend over an additional hour observing her in the chemo chair (office setting) after the hypersensitivity reaction occured, can anything be billed for the RN's additional work and time?

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    no only the physician face to face with the patient time is billable.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default ?53 modifier
    I just read an Alert from Oncology and Hematology newsletter regarding reactions. And the newsletter said that you should bill the 96413 with a 53 modifier to indicate that the procedure was intended to be a 96413 but was discontinued.
    Is this incorrect?

  6. #6
    Location
    Grand Rapids, MI
    Posts
    57
    Default
    We have been billing 96413 using the modifier 53 when a patient has a reaction.

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