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The E/M (CPT 99221), a code included within the MPFS, will be paid; however, the injection code (CPT 96365) is bundled into the E/M code and is not separately payable. A therapeutic, prophylactic, or diagnostic intravenous infusion or injection, other than hydration, is used for the administration of substances and drugs.
Some general pointers include:
Short description: Antineoplastic chemo enc. ICD-9-CM V58.11 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, V58.11 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes).
Encounter for antineoplastic chemotherapy Z51. 11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z51. 11 became effective on October 1, 2021.
Chemotherapy administration codes, 96400 through 96450, 96542, 96545, and 96549, are only to be used when reporting chemotherapy administration when the drug being used is an anti-neoplastic and the diagnosis is cancer.
Z51. 11 is attached to the billing for the administration of chemotherapy so would not be used by the provider when the patient is going to a hospital-owned infusion center.
11, Encounter for antineoplastic chemotherapy; or Z51. 12, encounter of antineoplastic immunotherapy as the first-listed or principal diagnosis.
9: Fever, unspecified.
818, “Encounter for other preprocedural examination.” Most pre-op exams will be coded with Z01. 818. The ICD-10 instructions say to use the preprocedural diagnosis code first, and then the reason for the surgery and any additional findings.
What are antineoplastic drugs? Antineoplastic drugs are medications used to treat cancer. Other names for antineoplastic drugs are anticancer, chemotherapy, chemo, cytotoxic, or hazardous drugs.
11 or Z51. 12 is the only diagnosis on the line, then the procedure or service will be denied because this diagnosis should be assigned as a secondary diagnosis. When the Primary, First-Listed, Principal or Only diagnosis code is a Sequela diagnosis code, then the claim line will be denied.
Z85. 3 can be billed as a primary diagnosis if that is the reason for the visit, but follow up after completed treatment for cancer should coded as Z08 as the primary diagnosis.
Intravenous (IV) infusions are billed based upon the CPT®/HCPCS description of the service rendered. A provider may bill for the total time of the infusion using the appropriate add-on codes (i.e. the CPT®/HCPCS for each additional unit of time) if the times are documented.
In-active neoplasm or cancer is coded when a patient is no longer receiving treatment for cancer and the cancer is in remission by using the V “history of” code (“Z” code for ICD-10).
Diagnosis Codes Never to be Used as Primary Diagnosis With the adoption of ICD-10, CMS designated that certain Supplementary Classification of External Causes of Injury, Poisoning, Morbidity (E000-E999 in the ICD-9 code set) and Manifestation ICD-10 Diagnosis codes cannot be used as the primary diagnosis on claims.
Meloxicam Injection, for Intravenous Use (Anjeso™) HCPCS Code J3490: Billing Guidelines.
J9070 Cyclophosphamide - CanMED: HCPCS.
J3490 or J3590 are approved and valid codes for Bevacizumab when treating neovascular age-related macular degeneration (AMD) by an Ophthalmologist.
Intravenous (IV) infusions are billed based upon the CPT®/HCPCS description of the service rendered. A provider may bill for the total time of the infusion using the appropriate add-on codes (i.e. the CPT®/HCPCS for each additional unit of time) if the times are documented.
When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy at that site, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the Z85 code used as a secondary code.
There are also codes Z85.6, Personal history of leukemia, and Z85.79, Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues. If the documentation is unclear as to whether the leukemia has achieved remission, the provider should be queried.
A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion '), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous such as tumors in different quadrants of the same breast, codes for each site should be assigned.
Chapter 2 of the ICD-10-CM contains the codes for most benign and all malignant neoplasms. Certain benign neoplasms , such as prostatic adenomas, may be found in the specific body system chapters. To properly code a neoplasm, it is necessary to determine from the record if the neoplasm is benign, in-situ, malignant, or of uncertain histologic behavior. If malignant, any secondary ( metastatic) sites should also be determined.
Code C80.0, Disseminated malignant neoplasm, unspecified, is for use only in those cases where the patient has advanced metastatic disease and no known primary or secondary sites are specified. It should not be used in place of assigning codes for the primary site and all known secondary sites.
When a pregnant woman has a malignant neoplasm, a code from subcategory O9A.1 -, malignant neoplasm complicating pregnancy, childbirth, and the puerperium, should be sequenced first, followed by the appropriate code from Chapter 2 to indicate the type of neoplasm. Encounter for complication associated with a neoplasm.
Code C80.1, Malignant ( primary) neoplasm, unspecified, equates to Cancer, unspecified. This code should only be used when no determination can be made as to the primary site of a malignancy. This code should rarely be used in the inpatient setting.
96446 refers to chemotherapy administration into the peritoneal cavity via indwelling port or catheter. It is not time based. This single code covers all infusions into the peritoneal cavity for that day and does not include peritoneocentesis.
If the doctor sees the patient at the hospital on the day of the chemo, they could bill the appropriate E&M code but could not bill for the administration (i.e., 96365-96379 or 96401-965 49). Chemotherapy administration codes reimburse primarily for the overhead/personnel costs of the infusion center. You can only bill for chemotherapy administration if you own the facility. If it is a hospital–based infusion center, you cannot collect for chemo administration. However, the amount of physician work associated with most chemo admin codes is only about 0.5 RVUs. You can charge for E&M codes if they are separately identifiable services. You then must document what was done and show medical justification for the visit. It should not be duplicative of clinic visits.
If the patient is seen only for a port flush, code 96523 should be used. If you use a de-clotting or thrombolytic agent, you should use code 36550. Also remember to use the J-code for the specific thrombolytic agent used. The diagnosis code should be the patient’s primary cancer and Z45.2 (encounter for adjustment and management ...
You can only bill for chemotherapy administration if you own the facility. If it is a hospital–based infusion center, you cannot collect for chemo administration. However, the amount of physician work associated with most chemo admin codes is only about 0.5 RVUs.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS Internet-Only Manual, Pub 100-02, Chapter 15, §50.4.1 Approved Use of Drug and §50.4.5 Off Label Use of Anti-Cancer Drugs and Biologicals
The purpose of this article is to provide billing guidance for chemotherapeutic agents, that are usually billed as “incident to” medications under Part B.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.