Q&A: Injection and infusion CPT coding for chemotherapy treatments
Q: A lung cancer patient presents to the infusion clinic to receive chemotherapy treatment per doctors’ orders.
The patient receives:
- A Carboplatin infusion from 15:00 to 16:35, for chemotherapy treatment
- A Gezmar infusion from 16:40 to 17:20, for chemotherapy treatment
- An Anzemet intravenous push
- A Decadron infusion from 14:30 to 15:00
- Hydration running with the chemotherapy
Which CPT codes would be used to report these services?
A: Let’s start with code selection for the infusion of Carboplatin. Code 96413 (chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug) would be used to report the first 90 minutes of the infusion. Code 96415 (chemotherapy administration, intravenous infusion technique; each additional hour) would be used to report the additional time spent on the Carboplatin infusion, since the infusion lasted for longer than 30 minutes past the previously billed hour.
Subsequent infusion CPT code 96417 (chemotherapy administration, intravenous infusion technique; each additional sequential infusion [different substance/drug] up to one hour) would be used to report the Gemzar infusion that ran for 40 minutes. If this infusion had run even longer and met the time requirement for an additional hour of infusion, then 96415 would be reported in conjunction with the 96417 to pick up the additional time of the sequential infusion, similar to how 96415 is used to report additional hours for the initial infusion.
Since the Anzemet IV push is not a chemotherapy drug, it would be reported with the non-chemotherapy IV push code 96375 (therapeutic, prophylactic, or diagnostic injection; each additional sequential intravenous push of a new substance/drug).
Finally, the infusion of Decadron would be reported with CPT code 96367 (intravenous infusion, for therapy, prophylaxis, or diagnosis; additional sequential infusion of a new drug/substance, up to one hour) for a sequential non-chemotherapy infusion.
The hydration that runs concurrently with the chemotherapy would not be coded separately.
Editor’s Note: Jugna Shah, MPH, president and founder of Nimitt Consulting answered this question during the HCPro virtual workshop, “Injections and infusions Live!: Practical Training Through JustCoding’s Virtual Workshop.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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