Oncology Infusion Coding: A Guide for Oncology Providers

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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
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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
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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

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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

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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

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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.

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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

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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.

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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_at_medicalbillersandcoders.com or
call us at 888-357-3226.