Infusion and Injection Coding-Part 4

Last month, “Spotlight on CPT” shared information on coding for injections and infusions in general. Part 4 of this series will focus on coding for chemotherapy and other highly complex drug or highly complex biologic agent administration. These types of drugs require significantly more training to administer and require much closer monitoring of the patient during administration, thereby warranting a separate series of codes.

Chemotherapy includes non-radionuclide antineoplastic drugs, specific monoclonal antibody medications, as well as other biologic response modifiers. While chemotherapy is generally considered as cancer treatment, it may also be used to treat non-cancer diagnoses such as lupus, rheumatoid arthritis, and bone marrow disease. In these instances, it is still appropriate to code from the chemotherapy series of codes (96401-96549). 

While the chemotherapy codes are the primary hierarchical codes to be assigned for this treatment, if additional medications are used either sequentially or independently, they may also be assigned. This would include medications such as steroids, antibiotics, anti-emetics, narcotics, and analgesics. Remember, though, that the fluid that is used to administer the chemotherapy is considered incidental to the procedure and should not be coded as hydration. 

Some of the chemotherapy codes are body-part specific. Coding professionals must be aware that codes exist for chemotherapy administered into the pleural cavity, the peritoneal cavity, or the central nervous system (intrathecal). Note that code 96440 for chemotherapy into the pleural cavity, requires and includes thoracentesis. Code 96450 for chemotherapy into the central nervous system, requires and includes the spinal puncture. 

Chemotherapy codes are also distinguished between intra-arterial and intravenous administrations, another factor that requires close attention when choosing the appropriate code to assign. The good thing is that the requirements for IV push and infusion remain that same in this category as from the injections and infusions we covered last month. Initial infusions are administered for up to 1 hour with a code for any additional hours, again meaning that more than 90 minutes of time must take place to assign the add-on code for the additional hour. 

Now, light has been shed on coding chemotherapy and other highly complex drug or highly complex biologic agent administration.

 

About the Author

Dianna Foley, RHIA, CHPS, CCS, CDIP, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as Eastern Gateway Community College’s program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.