How to code for Chemotherapy Administration
Chemotherapy administration services must be accurately documented and coded to properly bill for the resources and supplies consumed.
To ensure that the practice is compensated for the services rendered, the following documentation issues that can result in improper charge capture and billing should be noted:
It is not possible to establish that a drug infusion lasted more than 15 minutes, without start and stop times.
- Infusion services lasting 15 or fewer minutes are reported with IV push codes (94609 for chemotherapy IV push, or 96374 for therapeutic, prophylactic or diagnostic IV push injections).
- Infusion services lasting longer than 15 minutes are reported with time-based infusion codes.
Start and stop times are required to determine the appropriate concurrent or sequential code assignment, as well as any additional billable infusion time beyond the first hour of the infusion. Absent start and stop time documentation will result in the lowest level of chemotherapy administration service being billed.
Documentation of Anemia
- Anemia, a common side effect of chemotherapy, must be treated during the course of therapy.
- The provider should document the specific type of anemia to meet medical necessity requirements when billing for anemia drugs during the course of treatment.
Cross check the chemotherapy drug units administered against how that drug is set up in the office billing system, if chemotherapy drugs are hard-coded into a charge description master (CDM) or fee schedule. The maximum allowable fee per unit is based on the HCPCS Level II description of the chemotherapy drug. Errors are often made and drugs are frequently under-billed because they are hard-coded with a unit of one.