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IP Chemo

  1. #1
    Question IP Chemo
    Medical Coding Books
    Patient is receiving IP chemo into peritoneal cavity (96455) and also receiving Hydration for 2 hours with 4 drugs being pushed. (96361 and 96375). What is the appropriate way of billing this? This is how we are billing and we are getting denials.

    96445
    96361 X2
    96375 X4

    The issue is that there is 2 sites IV/IP... which normally would require a 59 modifier on the 96445, however that is our initial due to that is why the patient is here being treated. We have always been told that the chemo admin is always the initial and all other should be billed as subsequent or additional.

    Please help????
    Kristen Richard, CPC

  2. #2
    Location
    Columbia, MO
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    12,531
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    Honestly when hydration is being administered at the same time as chemo it is usually consider a part of the chemo tx and not separately billable. The IV site is for the pushes correct? or not. If so then hydration is not chargable only the pushes. If the IV site is for hydration alone then look at your dx you will need a dx for the necessity of hydration and will probably need to appeal.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Quote Originally Posted by mitchellde View Post
    Honestly when hydration is being administered at the same time as chemo it is usually consider a part of the chemo tx and not separately billable. The IV site is for the pushes correct? or not. If so then hydration is not chargable only the pushes. If the IV site is for hydration alone then look at your dx you will need a dx for the necessity of hydration and will probably need to appeal.
    Ok, I disagree with your answer. The hydration is billable. We have been billing it this way for years, and have been audited mulitple times. I think that if this was included in the chemo admin, an auditor would of pointed that out. As for the IV, this patient did not recieve IV chemo, pt received IP chemo. The IV site is for the hydration and the pushes, yes... the patient has cancer and that is our diagnosis. this claim is not being denied due to the diagnosis, or the hydration. Its being denied for ?? which is the initial. On a coding standpoint, I think that the hydration should be the initial which would bring me to code a 96360 for the 1st hour, and a 96361 for the addiontional hour, then the 96445 with a modifier 59 which shows a different site, and then the 96375 for the pushes... When billing a chemo pt, there MUST be an initial billed on claim.
    Kristen Richard, CPC

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
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    The hydration is not always billable.. If the fluids are being infused as a therapeutic measure for dehydration then yes it is billable, on the other hand if the fluid is used for the purpose of the pushes then it is not billable. That is what I was referring to in my response. The documentation must support hydration in order to bill it. If it is supported then you should bill the first push as initial with the 59 modifier to separate it from the IP and the hydration as subsequent.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    Quote Originally Posted by mitchellde View Post
    The hydration is not always billable.. If the fluids are being infused as a therapeutic measure for dehydration then yes it is billable, on the other hand if the fluid is used for the purpose of the pushes then it is not billable. That is what I was referring to in my response. The documentation must support hydration in order to bill it. If it is supported then you should bill the first push as initial with the 59 modifier to separate it from the IP and the hydration as subsequent.
    AH...I see... Yes the hydration is used for therapeutic reasons, so the patient does not get dehydrated during infusion. So your answer is to bill the first push (96374) with a modifier 59 and justify that as the initial. See the problem here is that the patient is being seen and treated for her IP chemo. In the CPT book it states "The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnositc services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections." that is listed on page 486 in green. So I am confused ....
    Kristen Richard, CPC

  6. #6
    Location
    Bettendorf, Iowa
    Posts
    133
    Default hydration
    I would bill 96374 for the initial IVP, 96375x3 for the other 3 IVP and then check your start and stop times. If the hydration extends past the last IVP 31 minutes or more then I would bill the 96361 with a 59.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  7. #7
    Location
    Columbia, MO
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    Quote Originally Posted by krssy70 View Post
    AH...I see... Yes the hydration is used for therapeutic reasons, so the patient does not get dehydrated during infusion. So your answer is to bill the first push (96374) with a modifier 59 and justify that as the initial. See the problem here is that the patient is being seen and treated for her IP chemo. In the CPT book it states "The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnositc services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections." that is listed on page 486 in green. So I am confused ....
    Yes so you code the chemo first as initial since it is IP. Then the pushes I am assuming are antiemetics so the first one is initial since is a separate route and second is subsequent and then last is the hydration. Now the hirearchy you are referring to should say for facility billing. and it referrs to how the codes are listed on the claim not to which service is initial. The initial service is for that which the line was started in the first place. Which I assume is for the antiemetics, the fluids were then left to run to prevent dehydration. I am basing this all on the way it was done in the Cancer research facility I worked in.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    Michellde was right in saying that- ie, the administration of fluid is considered INCIDENTAL Hydration and is not separately reportable (as per the guidelines for ChemoCPT page 435).
    This type of Iv fuilds is not typically therapeutic but it is as an incidental and more to say could be like prophylatic. whether the career pays or not is not for arguement here.The coding guidelines is our gold standard an dit not therapeutic in normal conventional chemo administration.
    Say for eg, we do give IV infusion,Hydration fluid, when we start blood transfusion. It is not therapeutic but it is as a prophylactic and as an incidental to that service, wherein it becomes a part and parcel of that transfusion service.

    I agree with the Iv push being reported too.. (that is admitted in the guidelines).
    The initial code that best describes the key or primary reason for the encounter should always be reported irrespective of the order in which the infusion or injections occur,
    also when the codes are reported by facility, the initial code should be selected using a hierachy whereby Chemotherapy are primary to therapeutics, prophylactics and diagnostic services which are primary to hydration services; in the order of infusion-then pushes -then injections.
    Krssy70, Could you please validate your reporting of Hydration over and beyond the CPT guidelines in your particular case of our discussion?

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