Coding Update for Infusions and Chemotherapy

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This audience would be medical offices and hospital outpatient departments that offer chemotherapy and infusion therapy. This would involve patients receiving treatment for dehydration, rheumatoid arthritis, lupus, Crohn’s disease, cancer, infections, and other conditions.  The specialties of oncology and rheumatology use these codes most frequently, but could also include infectious disease as well as others to a lesser degree.

Why should you attend?

As reimbursement decreases on services and drugs, it is important that providers are reporting all of the services that are payable to realize the maximum reimbursement for what they are performing.  To do that, staff has to understand the complex coding of these infusions and injections.  This type of reporting is frequently based on the time in which that patient is receiving treatment, with additional codes to be reported for different drugs, prophylactic circumstances and different methods of delivering the treatments along with reporting the drugs administered based on the dosage given.  There is also a method to report discarded drugs when it applies, which is important when the provider has purchased the drugs in advance, and need to at the very least, receive their money back on those drugs.

Description of the topic:

            Patients that need IV therapy or chemotherapy are required to receive this therapy over a period of time very often in several sessions.  The reporting of these services to the insurance companies require documentation to support the length of time the patient receives each drug(s) and the order in which the treatment is given.  CPT® codes reported are chosen based on the time it takes for the patient to receive their treatment in addition to the combinations in which they are given.  Once these codes and code combinations are determined, it is then realized what medications were received and the proper HCPCS codes are chosen, with the dosage, to report these drug(s) provided by the provider.  There are also insurance carrier guidelines that dictate what condition(s) or neoplasm can be treated by each of these drugs, to identify the medical necessity for the patient to receive the treatment, and the insurance carrier to reimburse for the services.  There are several methods in which these drugs can be administered and a combination of CPT® codes used for listing these methods.

Areas Covered in the Session:

  • Hydration
  • Chemotherapy Infusion
  • Different methods of infusion
  • Types of injections involved in these treatments
  • Subsequent and concurrent drug delivery
  • Reporting of add on codes in certain circumstances
  • Determining the appropriate HCPCS code(s) for drugs
  • Reporting discarded drugs
  • Reporting drugs that do not have a HCPCS code
  • Deciding the medical necessity based on diagnosis code


Who will benefit:

  • Physician
  • Nurse
  • Nurse practitioner
  • Physician assistant
  • Biller
  • Coder
  • Manager
  • Administrator


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