Presented by  Rebecca England, MHA, RHIA,
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Presentation on theme: "Presented by Rebecca England, MHA, RHIA,"— Presentation transcript:

Slide1

Presented by Rebecca England, MHA, RHIA, VHA-CMMelanie Romans, RHIA June 12, 2014

Chemotherapy Infusion Coding

Slide2
Overview

An in-depth look at the CPT coding rules and guidelines for the administration of chemotherapy and other highly complex biologic agents.

Slide3
Objectives

Slide4
Chemotherapy

Slide5
Documentation

Slide6
Documentation

Slide7
CPT Code Hierarchy

Slide8
CPT Code Hierarchy

Routes of administration

Slide9
Initial Codes

Each drug administration category has at least 1 initial code

Select only 1 initial code per

encounter

Slide10
Initial vs. Add-on- Chemotherapy

Initial

Add-on

96409

96411, 96367, 96361, 96375

96413

96417, 96415, 96366, 96367, 96411, 96368

Slide11
Initial vs. Add-on-Therapeutic

Initial

Add-on

96365

96366, 96367, 96368, 96375, 96361

96369

96370, 96371

96374

96375, 96367, 96361

Slide12
Initial vs. Add-on -Hydration

Initial

Add-on

96360

96361

Slide13
Prolonged Therapy

96416 – Initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump is not considered an initial or an add-on service and does not affect these rules

Slide14
96405-96406 –

Intralesional Chemotherapy

96405

describes the number of lesions treated, not the number of injections , and should be reported once, when one to seven lesions are treated. Even if a particular lesion is injected more than once.

Slide15

96405-96406 – Intralesional Chemotherapy

96406

is reported for

intralesional

chemotherapy for more than seven lesions.

Slide16
Concurrent Chemo Drug Administration

The chemotherapy section does not have a concurrent infusion code. This differs from the concurrent infusion code in the corresponding therapeutic code section.

Slide17
Concurrent Chemo Drug Administration

Multiple chemo drugs

given at the same session are usually

sequential

injections rather than given concurrently and should be reported with the proper code from the chemotherapy administration section.

Slide18
Time

Time starts when the drug starts infusing.

Slide19
Time

If an infusion is <15 minutes =

IV push code

If an infusion is 16 minutes up to 1 hour =

initial or sequential code

If an infusion is 91 minutes to 2 hours and 30 minutes =

initial or sequential and additional hour code

Slide20
CPT Assistant

Coding Tip!A “keep open” infusion of any type is not separately reported

Slide21
Why is the patient here?

The answer to that question will help determine the initial code choice, even though it may not be the first treatment given.

Slide22
Scenario #1

Service

Time

Initial

Minutes

CPT Code

Hydration

9:00-9:35

Antiemetic

9:35-10:15

Chemo 1

10:15-11:15

Chemo 2

11:15-12:50

Antiemetic

12:50–1:05

Slide23
Scenario #1

Service

Time

Initial?

Min

Code

Hydration

9:00-9:35

Subsequent

Antiemetic

9:35-10:15

Sequential infusion

Chemo 1

10:15-11:15

Initial Chemo

Chemo 2

11:15-12:50

Sequential Chemo

Antiemetic

12:50–1:05

Sequential

Slide24
Scenario #1

Service

Time

Initial?

Min

Code

Hydration

9:00-9:35

Subsequent

35

Antiemetic

9:35-10:15

Sequential infusion

40

Chemo 1

10:15-11:15

Initial Chemo

60

Chemo 2

11:15-12:50

Sequential Chemo

95

Antiemetic

12:50–1:05

Sequential

15

Slide25

ServiceTime

Initial?

Min

Code

Hydration

9:00-9:35

Subsequent

35

96361

Antiemetic

9:35-10:15

Sequential

40

96367

Chemo 1

10:15-11:15

Initial Chemo

60 (1

hr

)

96413

Chemo 2

11:15-12:50

Seq

Chemo

95 (1

hr

& 35 min)

96417

96415

Antiemetic

12:50–1:05

Sequential

15

96375

Scenario #1

Slide26
What is Included/Bundled?

Slide27
What is NOT

Included/Bundled

Slide28
Line and Port Flush

Slide29
Scenario #2

Service

Time

Initial

Min

CPT Code

Antiemetic

9:00

p.o.

Chemo 1

9:15-10:45

Chemo 2

11:00-1:35

Potassium

1:35-1:45

Flush lines

1:45

Slide30
Scenario #2

Service

Time

Initial?

Min

Code

Antiemetic

9:00

p.o.

Chemo 1

9:15-10:45

Initial Chemo

Chemo 2

11:00-1:35

Sequential Chemo

Potassium

1:35-1:45

Sequential

Flush lines

1:45

Slide31
Scenario #2

Service

Time

Initial?

Min

Code

Antiemetic

9:00

p.o.

Chemo 1

9:15-10:45

Initial Chemo

90

Chemo 2

11:00-1:35

Sequential Chemo

155

Potassium

1:35-1:45

Sequential

10

Flush lines

1:45

Slide32

ServiceTime

Initial

?

Min

Code

Antiemetic

9:00

p.o.

HCPCS

Chemo 1

9:15-10:45

Initial Chemo

90

96413

Chemo 2

11:00-1:35

Sequential Chemo

155 (2hr

& 35 min)

96417

96415x2

Potassium

1:35-1:45

Sequential

10

96375

Flush lines

1:45

No

Scenario #2

Slide33
Incidental Hydration

The fluid used to administer the drug(s) is considered incidental hydration and is not separately reported.

Slide34
Chemotherapy Services

Slide35
Other Highly Complex Drugs

Slide36

Other Highly Complex Drugs

Biologic Response Modifiers

Etanercept

(Enbrel)

– arthritis, psoriasis

Slide37

Other Highly Complex Drugs

Infliximab (

Remicade

)

Rituximab (

Rituxan

)

Alemtuzaab

(

Campath

)

Gemtuzumab

(

Mylotarg

)

Slide38

Other Highly Complex Drugs

Hormonal Anti-Neoplastic

Zoladex

,

Eligard

, Lupron

Slide39
Non-Chemotherapy Agents

Be aware of unfamiliar drugs given during the same encounter. They could be non-chemotherapy agents.

Slide40
Non-Chemotherapy Agents

Slide41
Non-Chemotherapy Agents

Slide42
Non-Chemotherapy Agents

Slide43

Example Patient is having an infusion of Oxaliplatin concurrently with Leucovorin.

Oxaliplatin

= chemo =

96413

Leucovorin

= non-chemo =

96368

Slide44
IVIG-intravenous immunoglobulin therapy

Administration code is

based on the route

IV infusion, IV push, initial, add-on

Slide45
IVIG - Product code based on brand

Slide46
Erythropoetin Stimulating Agents

Slide47
Units of EPO

Slide48
Official Coding Guidelines

If a patient admission/encounter is solely for the administration of chemo-therapy, immunotherapy or radiation therapy assign code

V58.0

, Encounter for radiation therapy, or

V58.11

, Encounter for antineoplastic chemotherapy, or

V58.12

, Encounter for antineoplastic immunotherapy as the

first-listed

or

principal

diagnosis

Slide49

Chemotherapy, Immunotherapy & Radiation therapy

If a patient receives more than one of these therapies during the same admission, more than one of the encounter codes may be assigned, in any sequence.

Slide50
Diagnoses - Encounter for Chemo

Slide51
Question #1

A patient with

small cell carcinoma of the lung

is seen in the Infusion Clinic for chemotherapy.

What

ICD-9 diagnosis

codes would you report?

Slide52
Answer #1

The primary diagnosis is

Encounter

for chemotherapy, code

V58.11

.

Code

162.9

, Malignant

neoplasm of bronchus and lung, unspecified should be assigned as a secondary diagnosis to identify the small cell carcinoma of the lung

.

Slide53
Question #2

A

patient with

small cell carcinoma of the lung

is

seen in the Infusion Clinic for chemotherapy.

What

ICD-10 diagnosis codes

would you report?

Slide54
Answer #2

The primary diagnosis is

Encounter

for chemotherapy, code

Z51.11

.

Code

C34.90

, Malignant

neoplasm of

unspecified part of unspecified bronchus

and

lung should

be assigned as a secondary diagnosis to identify the small cell carcinoma of the lung

.

Slide55
Blood Transfusion

Definition: Transfer of blood or blood component

from one individual (donor)

to another individual (receptor)

Slide56
Blood Products

Slide57
Tips for coding blood transfusions

Slide58
Blood Transfusions

CPT 36430 only once

per

date of service

Slide59
Blood Transfusion

Slide60
Example

Patient receives a transfusion of 2 units of fresh frozen plasmaCodes –

36430

P9017 – BL x2 units

Slide61
References

2014 CPT book CPT Assistant 2013 ICD-9 book

2013 ICD-10 draft

AHA Coding Clinic

Stedman’s Medical Dictionary

VHA Coding Guidelines v11.0

2014 HCPCS book

Slide62

QUESTIONS ???

Summary

Slide63
Contact

Rebecca.England@va.gov

Melanie.Romans@va.gov

Slide64

1 hour CE self report

DVA0603141116A

Elsevier Online Coding Training

https://

login.elsevierperformancemanager.com/systemlogin.aspx?virtualname=VAEES

Continuing Education

Slide65
VA Property Statement

Interested users are required to seek permission from

Barbara.Millas@va.gov

or

Jaime.Nasutie@va.gov

before

publishing any program materials

outside

the VA

firewall.

We appreciate your cooperation.

Slide66