Coding Chemotherapy
CPT codes 96401-96425 report chemotherapy administration by infusion, IV push, or injection. These codes are specific to time, technique, and additional substances added during the administration. These substances are prepared specifically for the patient and require advanced training for staff to manage the administration. Remember that significant patient risk is a consideration for this service. Report the substance, in addition to the administration, using the appropriate HCPCS Level II code(s).
- Codes 96440-96549 report services other than standard infusion/injection techniques.
- Report code 96446 when chemotherapy medication is delivered in the peritoneal cavity which is space within the abdomen via an indwelling catheter or port.
- Report code 96450 when chemotherapy is delivered into the central nervous system, for example, by intrathecal technique. This code includes spinal puncture.
- If a ventricular reservoir has been implanted for chemotherapy administration into the subarachnoid or intraventricular areas, report code 96542.
- Code 96549 reports an unlisted chemotherapy procedure.
For refilling or maintenance of the implanted reservoir, report code 96522. Vascular access devices frequently become clogged when in place over a period. For irrigation of an access device that has been implanted for drug delivery, report code 96523 if no other services are performed on that day. A significant, separately identifiable E/M service performed on the same day may be reported separately using the appropriate E/M code and appending modifier 25.
Remember, when multiple substances are delivered, only one initial administration code is reported, unless a separate IV site is required. When multiple types of infusions are reported, an established hierarchy should be utilized. For physician reporting, report the initial service as the primary reason for the encounter. For facility reporting, chemotherapy is reported primary to therapeutic, prophylactic, and diagnostic delivery which is primary to hydration. Infusions are primary to IV push which is primary to injections.
Patients receiving chemotherapy have a malignancy. Utilize the ICD-10-CM Table of Neoplasms to locate the correct site for reporting neoplasms. The primary site is the origin of the cancer. Cancers metastasized to secondary sites are reported with the malignant secondary category. There may be more than one secondary site. If the physician clinically is unable to determine the origin of the cancer, report C80.1 as the primary site (although this code should rarely be used). Blood cancers, such as leukemia and lymphoma, are in the index instead of the Table of Neoplasms. When reporting the final ICD-10-CM diagnosis, we always want to pay close attention to ICD-10-CM coding guidelines found in section I.C.2.e.
Q: A patient has an implanted intravenous pump for prescribed drug delivery at preset intervals. The patient is seen by the physician, who provides maintenance and refills the pump with the medication. What is the CPT code for this service?
A: 96522 Rationale: 96522 describes the refill and maintenance of an intra-arterial or intravenous implanted pump for drug delivery. The drug is separately reported with HCPCS Level II codes. In the CPT Index, we are going to look for Infusion Pump/Maintenance or Drug Delivery Implant/Maintenance and Refill/Intravenous.
Reference: FY 2023 ICD-10-CM code book & guidelines
