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Code This!

Scenario Week of October 14, 2008:
View Current Scenario

Patient presents for chemotherapy; weekly Taxol
Diagnosis: Breast Cancer

Intravenous Access:
IVAD SL/DL: Site left upper chest; 20 G ¾” huber gripper plus needle. Accessed without difficulty; flushed with 10cc NS and 5cc 100u/ml heparin and needle d/c’d intact; Labs drawn from IVAD

Drug Administration:
Infusion rate regulated using pump. Blood return noted prior and post infusion. Site patent and intact, free of redness, edema or complaint of discomfort. No evidence of extravasations. Patient tolerated administration of agents without incident and access discontinued per protocol.

DRUG 1/Route

Benadryl IV
Diphenhydramine 50 mg
Time 12:12pm
Med Amt/Dilutant 25mg 50ml 0.9%NS
NACL 0.9% 250ml
Stop Time 12:25pm


DRUG 2/Route

Decadron IV
Dexamethasone 1mg
Time 12:25pm
Med Amt/Dilutant 20mg 100ml 0.9% NS
NACL 0.9% 250 ml
Stop Time 12:44pm


DRUG 3/Route

Pepcid IV
Famotidine 20mg
Time 12:25pm
Med Amt/Dilutant 20 mg 100ml 0.9% NS
Stop Time 12:44pm


DRUG 4/Route

Paclitaxel IV
Paclitaxel 6mg/ml 50ml
Time 12:45pm
Med Amt/Dilutant 114mg 250ml 0.9% NS
NACL 0.9% 250ml
Stop Time 1:45pm

Diagnosis Codes

174.9 Breast cancer
V58.11 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 Paclitaxel, 30mg
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

Rationale
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.

 

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