Oncology Coding Challenge: When Infusion Runs Long
Posted on 14. Jul, 2009 by Editor in Coding Challenge
Question: The oncologist ordered a 90-minute chemotherapy infusion service, but the infusion lasted a few minutes longer than that. Is it OK to report the entire infusion time?
Answer: You may report the codes for the entire infusion time, but be sure the medical record notes why the infusion took longer than the prescribed time. You want to be able to prove medical necessity to an auditor because it is not appropriate to extend an infusion time just to increase reimbursement.
For example: If the patient has a chemotherapy infusion for one hour and 33 minutes, you would report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour and +96415 (… each additional hour [List separately in addition to code for primary procedure]) for the additional 33 minutes beyond the first hour.
As your question suggests, if the patient receives a 90-minute infusion, you would report only an initial hour code (96413). A parenthetical note following +96415 indicates it is “for infusion intervals of greater than 30 minutes beyond 1-hour increments.” 90 minutes is only 30 minutes beyond one hour. It is not “greater than 30 minutes” beyond the hour.
Bottom line: While some infusions will last longer than the prescribed 90 minutes, slowing the infusion rate to ensure billing for an additional code would not be appropriate.
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