Here’s the key to concurrent infusion coding.
Question: What are the appropriate codes for the first day of the FOLFOX4 regimen?
Answer: You should base your final coding decision on the documentation and the exact services your practice provides. But as a starting point, the FOLFOX4 regimen typically involves the patient receiving Oxaliplatin and folinic acid concurrently over two hours, followed by a 5-FU bolus on day one.
That same day, the patient begins a 22-hour infusion of 5-FU, often using an ambulatory pump. In this scenario, your day one claim would include:
- The Oxaliplatin (J9263, Injection, oxaliplatin, 0.5 mg) with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (… each additional hour [List separately in addition to code for primary procedure])
- The 5FU (J9190, Injection, fluorouracil, 500 mg) with +96411 (… intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure])
- The concurrent folinic acid (J0640, Injection, leucovorin calcium, per 50 mg) with +96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; concurrent infusion [List separately in addition to code for primary procedure]).
Key to concurrent: CPT Assistant (November 2005) indicates that the concurrent infusion code is appropriate for multiple infusions provided through the same IV line.
CPT Assistant (November 2006) clarifies that “to report a concurrent administration, the drugs cannot simply be mixed in one bag; there must be more than one bag.” If the drugs are mixed in a single bag you would report a single administration code.
Additionally: If you also report the ambulatory pump initiation, use 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump).
@ Oncology Coding Alert
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Infusions,
Initiation,
Intravenous Infusion,
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Coding Hint: Watch for ‘add-ons’ during Remicade sessions
Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 to 10:52. How should I report this encounter?
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Answer: This claim has a lot of moving parts; you can code for both the Remicade and the Benadryl administrations. Because your Benadryl infusion time was so short, however, you should not report an infusion code for that service.
Follow this two-step guidance on how to ethically maximize this claim:
Step 1 — Remicade: The total infusion time for the Remicade treatment was an hour and 42 minutes. Represent this time with the following:
• 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour
• +96415 (… each additional hour [List separately in addition to code for primary procedure]) for the remaining 42 minutes
• 555.0 (Regional enteritis; small intestine) linked to 96413 and +96415 to represent the patient’s condition
• J1745 (Injection, infliximab, 10 mg) x 20 for the supply of Remicade.
Step 2 — Benadryl: Payers will allow separate codes for any antiemetics the gastroenterologist provides during Remicade infusions. Since the Benadryl infusion took less than 15 minutes, however, you should consider it a push and report +96375 (Therapeutic, prophylactic, ordiagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]) with 555.0 attached. Also, report J1200 (Injection, diphenhydramine HCl, up to 50 mg) for the Benadryl supply.
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Chron's,
Coding Challenge,
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Prophylactic,
Remicade,
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Here’s the key to concurrent infusion coding.
