CMS recently published a revised coding standard for CPT codes 90000 – 99999. In this blog, we discussed CPT codes for Chemotherapy Administration Coding and minor notifications to guidelines.
Initial Service Code Reporting
CPT codes 96360, 96365, 96374, 96409, and 96413 are for ‘initial’ service codes. Only one ‘initial’ service code may be revealed for a patient’s care unless it is medically appropriate and justified for the drug or substance administrations to occur at particular intravenous connect sites. You can use adequate modifiers to notify two different ‘initial’ service codes.
Using Correct POS
Providers must report CPT codes 96360-96379, 96401-96425, and 96521-96523 for services provided in medical offices. Providers are not required to report drug therapy services provided in an institution established, such as a hospital outpatient department or emergency department. Providers are not required to individually register drug administration services performed in an Ambulatory Surgical Center (ASC) in connection with a Medicaid program ASC receivable process. When suitable, hospital outpatient facilities may reveal drug administration services individually. This article “physician” refers to M.D.s, D.O.s, and other professionals who bill Medicare claims to process contractors for offerings payable under the MPFS (Medicare Physician Fee Schedule).
CPT 99211 billing
HCPCS/CPT codes 96360-96375, 96377, and 96401-96425 for drug and chemo administration have been appreciated to include the task and practice expenses of CPT code 99211. Although CPT code 99211 is ineligible for reporting with chemotherapy and non-chemotherapy drug/substance administration HCPCS/CPT codes, other non-facility-based E&M CPT codes (e.g., 99202-99205, 99212-99215) are individually reportable with modifier 25 if the physician contains a tremendous and separately identifiable E&M service.
Because providers are not required to report drug administration assistance in a facility setting, a facility-based E&M CPT code must be written separately from a drug therapy CPT code unless the drug administration task is performed at separate patient encounter in a non-facility setting on the same date of service. The E&M code should be noted with modifier 25 in such cases. Healthcare facilities may report drug therapy services and facility-based E&M codes (e.g., 99281-99285, G0463) under the OPPS (Outpatient Prospective Payment System) if the E&M service is substantial and separately knowable. Modifier 25 should be attached to the E&M code in these cases.
Incorrect Use of CPT 96523
Irrigation of an implanted vascular access link or device before or after the government of chemotherapeutic or non-chemotherapeutic drugs is considered part of the drug therapy service and is not individually reportable. In these cases, do not report CPT code 96523.
Billing, restocking and maintenance of an implantable pump/reservoir for systemic drug delivery.
The restocking and maintenance of an implantable pump or reservoir for systemic delivery are described by CPT code 96522. The pump or reservoir must be capable of releasing a drug at a predetermined rate. CPT code 96522 should not be used to report access to a nonprogrammable implantable device for infusion(s) or chemotherapy administration.
CPT codes 96522 (Refilling and maintenance of an implantable pump or reservoir for delivery of drugs, systemic (e.g., intravenous, intra-arterial)) and 96521 (Refilling and maintenance of a portable pump) must not be reported in conjunction with CPT codes 96416 (Initiation of prolonged intravenous chemotherapy infusion (more than 8 hours), needing the use of a portable or implanted devices pump) or 96425 (Chemotherapy administration The immediate filling and maintenance of a portable or implantable pump are covered by CPT codes 96416 and 96425. CPT codes 96521 and 96522 are used to report subsequent pump refilling.
Accessing or flushing an implantable peripherally-placed intravenous catheter port (external to the skin), subcutaneous port, or nonprogrammable subcutaneous pump is not covered by CPT codes 96521 and 96522. Accessing and rinsing these devices is a built-in service that facilitates these infusions and is not considered separately.
CPT Code 96368 for billing
Simultaneous intravenous infusion of an antiemetic or another non-chemotherapeutic drug with intravenous infusion of chemotherapeutic agents may be reported as CPT code 96368. (Concurrent intravenous infusion). CPT code 96368 can only be reported with one unit of service per patient interaction, regardless of several simultaneously infused drugs or the duration of the concurrent infusion (s). Concurrent hydration with chemotherapy is not separately reportable.
We have shared some CPT codes and guidelines for regard only; for correct use, please refer to the detailed code description. If you require medical and coding assistance, please contact us at firstname.lastname@example.org
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