||Encounter for chemotherapy
CPT codes/HCPCS codes
|96413 x 1
||Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
|J9265 x 4
Use this code for Taxol
|90775 x 2
||Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)
|J1200 x 1
||Injection, diphenhydramine HCI, up to 50mg
Use this code for Benadryl
|J1100 x 20
||Injection, dexamethasone sodium phosphate, 1 mg
|S0028 x 1
||Injection, famotidine, 20 mg
Use this code for Pepcid
This code is not covered by Medicare
|J1642 x 100
||Injection, heparin sodium, (heparin lock flush), per 10 units
Per CPT guidelines, chemotherapy administration is reported for each method of administration; in this case only one chemo drug was administered. Additionally, for multiple drug infusions, only one initial code is appropriate and should reflect the primary reason for the visit; in this case it is chemotherapy, so the sequential drugs administered are considered “each additional.”
According to CPT Assistant (June 2007), when more than one drug/substance is mixed in one bag, it is considered one infusion. In this case, Decadron and Pepcid were mixed together, so only one administration is allowed but both drugs are reported.
The November 2005 CPT Assistant notes the definition for an IV push indicates an infusion of less than 15 minutes. There are also guidelines regarding additional hours of sequential infusion where time is based on infusion of more than 30 minutes per drug. In this example, Decadron, Pepcid, and Benadryl do not meet the guidelines for “additional hour of infusion,” but qualify as an IV push.
Due to CCI edits, the blood draw from the IVAD (36591) bundles into any service on the same day and is not reported separately. Also, the irrigation of the IVAD (96523) bundles into other services and is not reported separately.
CPT guidelines also indicate that supplies, such as such as tubing, syringes, and supplies, are not to be billed separately.
HCPCS codes are billed as quantities based on units of measure given. According to the HCPC definitions, the following drugs are billed based on quantity:
- J1200 x 1 as 25mg was administered; code description is used for up to 50mg
- J1100 x 20 as 20mg was administered; code description is used for 1mg
- S0028 x 1 as 20mg was administered; code description is used for 20mg; however, this code is not reportable/payable by Medicare
- J9265 x 4 as 114mg was administered; code description is used for up to 30mg
In addition, normal saline was used as a mixed/additive to the drug, so this is considered incidental hydration according to CPT guidelines and is not reported in addition to the drug administered.