Oncology Infusion Coding: A Guide for Oncology Providers

2. Oncology Infusion Coding: A Guide for Oncology Providers Oncology infusion therapy is a critical component of cancer treatment, and it's important that oncology providers are well-versed in oncology infusion coding. Proper coding ensures accurate billing and reimbursement, which is essential for the financial viability of oncology practices. In this article, we'll provide an overview of oncology infusion coding and highlight some key considerations for oncology providers. What is Oncology Infusion Therapy Image Source

3. Oncology Infusion Coding: A Guide for Oncology Providers Oncology infusion therapy refers to the administration of medications, fluids, and/or blood products directly into a patient's bloodstream through an IV or other access device. This therapy is used to treat a wide range of cancers and cancer-related conditions, including chemotherapy, immunotherapy, blood transfusions, and hydration. Oncology Infusion Coding Overview The coding and billing for oncology infusion therapy can be complex and challenging, as it involves a variety of different codes and rules. The primary coding systems used for oncology infusion therapy include the Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and International Classification of Diseases (ICD) codes. We shared common codes used in oncology infusion coding along with their short descriptions. Common CPT Codes in Oncology Infusion Coding CPT codes are used to describe medical procedures and services, including oncology infusion therapy. The CPT codes for oncology infusion therapy include codes for the administration of chemotherapy, immunotherapy, hydration, blood transfusions, and other medications. Providing complete descriptions and

4. Oncology Infusion Coding: A Guide for Oncology Providers • guidelines is not possible as CPT is a registered trademark of the American Medical Association (AMA). We shared these codes for provider education purposes only. • Following are some of the most commonly used codes: • 96413: Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug • 96415: Chemotherapy administration, intravenous infusion technique; each additional hour, single or initial substance/drug • 96416: Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours) • 96417: Chemotherapy administration, intravenous infusion technique; each additional hour prolonged infusion (more than 8 hours) • 96365: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour • 96366: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour

5. Oncology Infusion Coding: A Guide for Oncology Providers • 96367: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour • 96368: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion of two or more substances/drugs, up to 1 hour • It's important to note that these codes are constantly updated, so oncology healthcare providers should consult with the most recent CPT code book or online resources to ensure they are using the correct codes. Additionally, proper documentation of the infusion procedure and any drugs or substances administered is critical for accurate coding and billing. • Common HCPCS Codes in Oncology Infusion Coding • Image Source

6. Oncology Infusion Coding: A Guide for Oncology Providers • HCPCS codes are used to describe medical supplies and equipment, including oncology infusion supplies such as IV tubing, syringes, and infusion pumps. These codes are used to bill for the supplies and equipment used during infusion therapy. • Following are some examples of commonly used HCPCS codes for oncology infusion therapy: • A4211: Infusion set, gravity • A4212: Infusion set, pressure • A4213: Supplies for maintenance of drug infusion catheter, per week (external access device) • A4214: Supplies for maintenance of drug infusion catheter, per month (external access device) • A4215: Infusion pump, nonprogrammable • A4220: Infusion pump, single or multichannel, programmable • A4221: Supplies for maintenance of drug infusion pump, per cassette or bag (list drugs separately) • A4222: Supplies for external drug infusion pump, per cassette or bag (list drugs separately) • A4223: Supplies for external insulin infusion pump, syringe-type cartridge, sterile, each • A4230: Infusion supply, not otherwise classified

7. Oncology Infusion Coding: A Guide for Oncology Providers • It's important to note that the HCPCS codes used for oncology infusion therapy may vary depending on the specific supplies and equipment used during the procedure. Healthcare providers should consult with coding experts or reference coding manuals to ensure accurate billing and coding for oncology infusion therapy. • Common ICD Codes in Oncology Infusion Coding • ICD-10 CM codes are used to describe a patient's diagnosis or condition. These codes are used to justify the medical necessity of oncology infusion therapy and to support the medical necessity of the procedure. • Following are some common ICD-10 CM codes used in oncology infusion: • C00-C97 Malignant neoplasms: This is the most common category of ICD-10 codes used in oncology infusion therapy. It includes codes for various types of malignant neoplasms, including carcinomas, sarcomas, lymphomas, and leukemias. • D50-D89: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism: This category of codes include codes for anemia, coagulation disorders, and other blood-related conditions that may require oncology infusion therapy.

8. Oncology Infusion Coding: A Guide for Oncology Providers • 11: Encounter for antineoplastic chemotherapy: This code is used to indicate that the patient is receiving chemotherapy for the treatment of a malignancy. • 12: Encounter for antineoplastic immunotherapy: This code is used to indicate that the patient is receiving immunotherapy for the treatment of a malignancy. • 81: Encounter for therapeutic drug monitoring: This code is used to indicate that the patient is undergoing therapeutic drug monitoring as part of their oncology infusion therapy. • 0: Kidney transplant status: This code is used to indicate that the patient has received a kidney transplant and is now undergoing oncology infusion therapy. • It's important to note that these codes are just a sample of the many codes that may be used in oncology infusion coding. The specific codes used will depend on the patient's diagnosis, the type of infusion therapy being administered, and other factors. Accurate and detailed documentation is essential to ensure that the correct codes are used for billing and reimbursement purposes. • Key Considerations for Oncology Infusion Coding • Documentation is key. Accurate and detailed documentation is essential for proper oncology infusion coding. Healthcare providers should document type and dosage of medication administered, route of

9. Oncology Infusion Coding: A Guide for Oncology Providers • administration, the duration of the infusion, and any adverse reactions or side effects. This documentation should be included in the patient's medical record. • Understand the rules for multiple infusions. When a patient receives multiple infusions during the same visit, it's important to understand the rules for billing and coding these infusions. Depending on the type of infusion and the length of time it takes, multiple infusions may need to be billed separately or bundled together. • Keep up-to-date with coding changes. The coding and billing rules for oncology infusion therapy are constantly evolving, so it's important for healthcare providers to stay up-to-date with changes to the coding systems and rules. This can be done through attending coding and billing seminars, reading industry publications, and consulting with coding experts. • Work with coding experts. Given the complexity of oncology infusion coding, it's often beneficial for oncology healthcare providers to work with coding experts. These experts can help providers navigate the coding and billing rules, ensure proper documentation, and maximize reimbursement.

10. Oncology Infusion Coding: A Guide for Oncology Providers • Oncology infusion therapy is an essential component of cancer treatment, and proper coding is essential for accurate billing and reimbursement. By understanding the coding systems and rules, documenting accurately, staying up-to-date with coding changes, and working with coding experts, oncology healthcare providers can ensure proper oncology infusion coding and billing for oncology infusion therapy. • Medical billing and coding are crucial components of the healthcare industry, and oncology billing requires a high level of expertise and knowledge. Therefore, partnering with a medical billing and coding company such as Medical Billers and Coders (MBC) can be a smart choice for oncology practices. MBC is a leading medical billing and coding company that provides specialized services to various medical specialties, including oncology. • MBC's team of certified coders and billing experts has in-depth knowledge of the latest oncology coding and billing regulations and practices, ensuring accurate billing and maximizing reimbursements. To know more about our oncology billing services, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.