Health Information Management

Q&A: IV push, continuous infusions

APCs Insider, August 29, 2008

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Q: How should I code the following:
  • Leucovorin started at 12:15 p.m. and ended at 2:27 p.m.
  • Fluorouracil started at 2:15 p.m. and ended at 2:20 p.m. (Note: give bolus after completion of Leucovorin).
  • Fluorouracil continuous infusion during 46 hours via CADD pump after the bolus dose, started at 2:37 p.m.

Should we report 96411 for the bolus and 96521 for the CADD pump? Or should we report 96416 for the bolus and 96521 for the CADD pump? Also, which code should we report for the discontinuation of the CADD pump when the patient returns after 46 hours?

A: This scenario suggests that staff did not start the IV site for the push and infusion of Leucovorin in the same arm as the pump site. Report the bolus of Fluorouracil (5-FU) as the initial chemotherapy service, even though it was given 12 minutes prior to the end of the Leucovorin infusion,. Staff administered this drug in less than 15 minutes and therefore it meets the criteria for an initial IV push (CPT code 96409 x 1).
As stated in the May 2007 CPT Assistant on pp. 4 and 11, Leucovorin is not classified as:
Antineoplastic agents that  either modulate the effect of the antineoplastic agent or protect normal tissues ... Drugs administered as modulating agents in addition to an antineoplastic agent infusion should not be reported with codes in the 96000 series of codes but would be reported appropriately by a concurrent or sequential therapeutic infusion or injection code(s), depending upon the circumstances related to the hierarchy and method of administration.
APC Answer Letter recommends reporting a concurrent infusion code (CPT code 90768 x 1) for this administration. As stated in the parenthetical notation on p. 384 of the CPT 2008 Professional Edition, “report 90768 only once per encounter,” regardless of the number of infusion hours. This was followed by the initiation of continuous infusion of Fluorouracil (5-FU) via CADD pump as the final service. The scenario above does not clearly indicate whether staff established the infusion pump access site during this encounter or whether the access site was already present and, therefore, only needed to be refilled. However, the question indicates that staff established the site for this encounter.
The September 2007 CPT Assistant states on p. 4 that in scenarios in which the patient receives an:
Intermittent regimen (during which there is a period of time in which the patient is disconnected from an infusion pump), each time a new course of therapy is initiated it would be appropriate to report code 96416 ... Perhaps the most common circumstance is with the FOLFOX regimen. Every two weeks, the patient is hooked up to a 46-hour infusion of 5-FU, which is discontinued at the conclusion.
Report the situation with the following codes:
  • 96409 (Initial IV push/chemotherapy)
  • J9190 (5-FU)
  • 90768 (Concurrent infusion/nonchemotherapy)
  • J0640 (Leucovorin)
  • 96416 (Pump initiation/46-hour continuous infusion)
  • J9190 (5-FU)
You may use an E/M code to report the facility service when the patient returns to the department to have the pump discontinued. Documentation should reflect the service provided by nursing staff members, any questions asked by the nurse and the patient responses, and any additional treatment or site care instructions.

(This Q&A is borrowed from APC Answer Letter. To view the original Q&A, click here.)

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