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HELP! Oncology Coding - Concurrent Chemo

  1. #1
    Default HELP! Oncology Coding - Concurrent Chemo
    Medical Coding Books
    Her is the scenario that is giving me some issues,

    Day 1 - Patient got hooked up on a 5FU (Adrucil) pump on after recieving Cisplatin + PreMeds

    Day 2 - While patients pump is STILL RUNNING the Cisplatin + PreMeds are being infused (concurrent with 5fu) through the SAME ACCESS (port)

    Day 3 - Same as Day 2

    Day 4 - Same as Day 2

    Day 5 - Pump Dissconnect

    Please advise on how you would code/bill Days 2-4. Do you bill the Cisplatin as 96413 (as a first drug first hour) or as 96549 (unlisted because it is being run concurrent with 5FU). Also do you bill the PreMeds as Concurrent (90768, can only value one i believe)

    Thank you for your QUICK response. If you need clarification please let me know.
    Danielle Kiehl

  2. #2
    Location
    Dallas Chapter
    Posts
    30
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    Quote Originally Posted by Dillie2003 View Post
    The 5FU is not refilled, stopped, or anything during days 2-4. it is just disconnected on day 5
    Are all of the drugs running together in the pump or is the patient coming in the office for the Cistiplatin and other meds?
    Last edited by jsth10; 09-04-2008 at 10:24 AM.
    Josalyn Smith, CPC

  3. #3
    Default
    i dont believe that we would charge for the pump on day 2-4, we are not filling/re filling/or disconnecting it. it is just present.
    Danielle Kiehl

  4. #4
    Location
    Dallas Chapter
    Posts
    30
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    Quote Originally Posted by Dillie2003 View Post
    i dont believe that we would charge for the pump on day 2-4, we are not filling/re filling/or disconnecting it. it is just present.
    No, you just bill the pump charge once for the first day, but are the other drugs run along with the pump or is the patient actually coming in the office for the Cistiplatin and meds?
    Josalyn Smith, CPC

  5. #5
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    the patient comes back to the office, and WHILE the pump is running we infuse the premeds, hydration with mg and k, and then the cisplatin. they are all going into the same access too.
    Danielle Kiehl

  6. #6
    Location
    Dallas Chapter
    Posts
    30
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    Quote Originally Posted by Dillie2003 View Post
    the patient comes back to the office, and WHILE the pump is running we infuse the premeds, hydration with mg and k, and then the cisplatin. they are all going into the same access too.
    Then yes I would do just like you suggested in your first question. Code the Cistiplatin 96413 and the meds concurrent, but remember you can only use the 90768 once per encounter. You had it right! You answered your own question
    Josalyn Smith, CPC

  7. #7
    Location
    San Antonio, Tx
    Posts
    73
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    Not knowing the pre-meds or the times for your pre-meds, I will assume that the following pre-meds and their times are as follows:
    Drug Qty Infusion time Admin
    Day 1: J1100 10mg 20min (eg: 8:00am-8:20am) 90767 J1200 25mg 20min (eg: 8:21am-8:41am) 90767
    J2780 50mg 20min (eg: 8:21am-8:41am) 90767
    J3480 40meq 1hr10min (pre-hydra 9:00-10:10) 90761
    J3475 1000mg 1hr10min (pre-hydra 9:00-10:10) 90761
    J9060 50mg 35min (10:05-10:40) 96413
    J2150 25% in 50ml 35min (10:05-10:40)
    J3480 40meq 1hr15min (post hydra 10:45-12:00) 90761
    J3475 1000mg 1hr15min (post hydra 10:45-12:00) 90761
    J9190 3500mg Continuous Infusion X5days 96416 59
    Admins are posted as: 90767 X2, 90761 X2, 96413 X1, 96416 w/Mod 59 X1

    Day 2-5 are a repeat with the exception of the 96416. That is if you give the same pre-meds, hydra and cisplatin each day. On day 6 you DC the pump. This is just an example. You are correct in that you are allowed 1 concurrency per day. I hope this helps.

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