Health Information Management

Use unlisted code 96549 to report concurrent chemotherapy

APCs Insider, March 9, 2007

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Use unlisted code 96549 to report concurrent chemotherapy

QUESTION:We are confused about how or whether we should code concurrent chemotherapy. The CPT Manual states that 90768 should be used with 96413 and 96415, which are both IV chemotherapy infusion codes. However, the November 2005 CPT Assistant states that there is not a code for concurrent chemo, so we should use 96549 (Unlisted chemotherapy procedure).

The 2007 CPT Coders' Desk Reference states that 90768 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; concurrent infusion [List separately in addition to code for primary procedure])should be used for infusions "other than chemo drugs."

Do you know which source is correct? My tendency is to follow the 2007 CPT Manual, which means that we should use 90768 for concurrent chemotherapy. Do you agree?

ANSWER:CMS states the following in Transmittal 1139 ("January 2007 Update of the OPPS"):

Hospitals are instructed to use the full set of CPT codes, including those codes referencing concepts of initial, concurrent, and sequential, to bill for drug administration services furnished in the hospital outpatient department beginning January 1, 2007. In addition, hospitals are instructed to continue billing the HCPCS codes that most accurately describe the service(s) provided.

The CPT Manual, instructions along with CPT Assistant guidance, supports CMS' directive listed above. Per the CPT knowledge base and the November 2005 CPT Assistant, if staff mix or give chemotherapy agents concurrently, report unlisted chemotherapy administration code 96549. Due to a lack of evidence of current practice standards, there is no code at this time for concurrent administration of chemotherapeutic drugs.

Report CPT code 90768 for concurrent infusion of a non-chemotherapy drug.



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