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Q&A tackles coding questions about injections and infusions

JustCoding News: Outpatient, December 2, 2009

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Coding for injections and infusions continues to be an area fraught with confusion. Coding depends on the various therapies involved, the number of access sites, as well as start and stop times. The following Q&As explore challenging injection and infusion coding scenarios.

Q. We administered two different chemotherapy drugs to a patient using two different access sites, a Mediport®, and a peripheral IV. We did this to reduce the time the patient spent in the infusion clinic. How should we code this scenario?

A. The following CPT codes and modifiers are relevant to the scenario you describe:

  • 96413—Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug
  • +96415—Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure)
  • 96416—Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than eight hours), requiring use of a portable or implantable pump
  • +96417—Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to one hour (list separately in addition to code for primary procedure)
  • -59—Distinct procedural service

The Medicare Claims Processing Manual, chapter 4, Part B Hospital, offers the following guidance in 230.2, section C:

Beginning in CY 2007, CPT instructions allow reporting of only one initial drug administration service, including infusion services, per encounter for each distinct vascular access site, with other services through the same vascular access site being reported via the sequential, concurrent, or additional hour codes.

Proper coding in the scenario you describe includes CPT code 96413 for the chemotherapy infusion up to one hour infused through the Mediport® and CPT code 96413-59 for the chemotherapy infusion up to one hour infused through the peripheral IV site. Use the appropriate add-on codes of 96415, 96416, or 96417 per access site, appending modifier -59 to the second IV access site. In this scenario, it would be the peripheral IV site.

Q. My question pertains to the following CPT chemotherapy infusion codes:

  • +96411—Chemotherapy administration; intravenous, push technique, each additional substance/drug (list separately in addition to code for primary procedure)
  • 96413—Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug
  • +96415—Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure)
  • 96416—Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than eight hours) requiring use of a portable or implantable pump
  • +96417—Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up on one hour (list separately in addition to code for primary procedure)

Here is the scenario. A patient presents for a two-hour infusion of oxaliplatin. The patient then receives a 10-minute IV push of fluorouracil (5-FU). Finally, initiation of prolonged infusion of 5-FU greater than eight hours by portable or implantable pump begins.

Should we bill CPT codes 96413, 96416, and +96411? Or should we bill 96416, +96417, +96415 x 1 (oxaliplatin), and +96411?

A. Based on the clinical scenario you describe, and assuming the chemotherapy service is rendered in a hospital-based facility setting, the proper CPT code assignment is:

  • 96413 x 1 for the first hour of oxaliplatin
  • +96415 x 1 for additional hour of oxaliplatin
  • +96411 for the IV push of 5-FU, and
  • 96416 x1 for the initiation of 5-FU on the pump

Refer to the instructional notes in the 2009 CPT Manual notes under Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration on p. 437 and also under Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions and Other Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration on p. 434.

The instructional notes and guidance provided in conjunction with the order of chemotherapy administration indicate that the above code assignments best fit the clinical scenario in your question.

Q. My question pertains to the following CPT codes:

  • 96365—IV infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to one hour
  • +96366—IV infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)
  • +96375—Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential IV push of a new substance/drug (list separately in addition to code for primary procedure)

Please advise whether the following services provided in a hospital outpatient setting are coded accurately.

Patient receives the following medication:

  • Diltiazem 5 mg IVP at 1525 (code +96375)
  • Diltiazem 5 mg IVP at 1535 (no code assigned)
  • Diltiazem 5 mg IVP at 1553 (no code assigned)
  • Diltiazem drip 100 mg in 100ns infused 1725–1900 (codes 96365 x 1 and +96366 x 1)

A. Report 96365 for the first hour of the diltiazem drip 100 mg in 100 ccs of normal saline infusion.

Report +96366 for the remaining 35 minutes of the diltiazem drip 100 mg in 100 ccs of normal saline infusion.

Report +96375 for the diltiazem 5 mg IVP at 1525.

The remaining two IV push administrations of diltiazem 5 mg were not administered within 30 minutes of the first and subsequent doses. Therefore, do not report them with 96376 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential IV push of the same substance/drug provided in a facility [list separately in addition to code for primary procedure]).

Q. My question pertains to the following CPT codes:

  • 31500—Intubation, endotracheal, emergency procedure
  • 96374—Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); IV push, single or initial substance/drug
  • +96375—Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential IV push of a new substance/drug (list separately in addition to code for primary procedure)
  • 99144—Moderate sedation services (other than those for services described by codes 01000–01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time

Please explain how to code this scenario. We administer rapid sequence intubation to a patient and report CPT code 31500. May we bill codes 96374 and +96375 for drugs administered IVP immediately prior to intubation or is this part of the procedure?

Also, may we bill code 99144 when the patient is awake, alert, and oriented prior to the procedure?

A. CPT codes 96374 and +96375 are considered integral to the intubation procedure, therefore you cannot separately code and bill them.

Refer to the National Correct Coding Initiative (NCCI) facility edits governing codes 31500, 96374, and +96375. Codes 96374 and +96375 have a status 1 indicator associated with column 1 code 31500. Status indicator 1 denotes that a modifier may be appropriate.

If you are administering the IV pushes just prior to intubation to assist in rapid intubation, you should not report a code for the IV pushes. However, if the IV pushes are separate and distinct from the intubation, assigning the IV push codes with modifier -59 (distinct procedural service) is appropriate.

Review Appendix G of the 2009 CPT Manual for information about correctly assigning code 99144. CPT codes 99143–99145 may be billed in a facility or non-facility setting. However, these services are coded and separately reimbursed when Appendix G does not list the procedure requiring moderate sedation. No NCCI edits exist for codes 99143–99145 and column 1 code 31500. The absence of NCCI edits does not necessarily indicate that you can appropriately bill code sets together.

Standards of care govern the ultimate assignment of code pairs or sets. Refer to the recently updated Wisconsin Physician Service local coverage determination governing moderate sedation for a discussion on appropriate assignment of a moderate sedation code.

Editor’s note: The Q&As in this article were originally published in the November and December issues of APC Answer Letter.



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