Post on 14-Jan-2020
Applying CPT and HCPCS C-Codes and Rules for Drug Administration Services to Clinical Scenarios
IMPORTANT – PLEASE READ
The information provided in this handout is informational only and should not be taken as an “official” answer of how to report codes and units for the services described in these clinical scenarios. Our audioconference speakers have provided this in an
attempt to help hospitals sort through a number of drug administration reporting issues, but each hospital must make its
own determination of how to report these services to Medicare and non-Medicare payers. If you are confused or disagree, we urge you to request guidance from your FI and CMS . We cannot provide any further information or explanations at this time. If you have further questions, please contact Nimitt Consulting at
jugna@nimitt.com to engage consulting services.
Answer for Clinical Example 1: Emergency Department Visit for a
Gastric Ulcer Patient
ED Visit Example
Service Time Explanation 2006 Codes 2006 CodesIVP 14:00 Protonix 90774 x 1 C8952 x 1
IVP 14:10 Demoral 90775 x 1 C8952 x 1
IVP 14:15 Ativan 90775 x 1 C8952 x 1
ED Visit ED Level III 99283 x 1 99283 x 1
2006 CPT Codes for non-
Medicare use
2006 HCPCS C-codes for
Medicare Use
Page 1
Answer for Clinical Example 2: Emergency Department and Observation Visit for a
Gastric Ulcer Patient
Service Time Explanation 2006 Codes 2006 CodesIVP 14:00 Protonix 90774 x 1 C8952 x 1
IVP 14:10 Demoral 90775 x 1 C8952 x 1
IVP 14:15 Ativan 90775 x 1 C8952 x 1
ED Visit ED Level III 99283 x 1 99283 x 1
Observation14:30 - 16:30 Admit to Obs 99235 x 2 G0378 x 2
Infusion started in Observation
14:30 - 16:30
Therapeutic Infusion
90767 x 1 90766 x 1
C8950 x 1 C8951 x 1
IVP 16:30 Dilaudid 90775 x 1 C8952 x 1
2006 HCPCS C-codes for
Medicare Use
ED and Observation Example
2006 CPT Codes for non-Medicare use
Page 2
Answer for Clinical Example 3:Multiple Push Injections of the Same Drug
Chemo Regimen
Service Time Explanation2005 CPT
Codes 2006 CPT Codes2006 C-Codes
IVP 1000-1005 Lasix 90784 x 1 90774 x 1 C8952 x 1*
IVP 1110-1115 Lasix 90784 x 1
IVP 1300-1305 Lasix 90784 x 1
IVP 1500-1505 Lasix 90784 x 1
2005 Hospital
Reporting
2006 CPT Codes for non-
Medicare use
2006 HCPCS C-Codes for Medicare
Use
Answer for Clinical Example 4: Concept of Concurrent Drug and CMS
Administration as Presented at the CPT Symposium in Chicago
Service Time Explanation
2006 CPT Codes for non-
Medicare use2006 C-Codes for
Medicare UseIVPB 1000-1100 Antibiotic 1 90765 x 1 C8950 x1
IVPB 1000-1100 Antibiotic 290768 x 1
No Medicare C-code available to report concurrent infusion
IVP 1115-1125 Phenrgan 90775 x 1 C8952 x 1
This is the answer presented by physicians at the CPT meeting in Chicago. We believe that there is no way to report the second antibiotic infusion on the Medicare side given that there is no code available and also because both infusions are of the same type. If the concurrent infusion was of a different type (i.e., a chemotherapy drug infusion), then we believe guidance from Transmittal 785 would allow us to report both the antibiotic and the chemo infusion. Page 4
Answer for Clinical Example 5: Two Chemotherapy Push Drugs with a
Non-Chemotherapy Drug
Service Time Explanation 2006 Codes 2006 codesIVP 9:00 PS-341 (chemo) 96409 x 1 C8953 x 1
IVP 10:02 5FU (chemo) 96411 x 1 C8953 x 1
IVP 9:30Leucovorin (non-chemo)
90775 x 1 C8952 x 1
Two Different Chemo Drugs Given IVP and Non-Chemo by IVP
2006 CPT Codes Non-Medicare
Use
2006 CPT and HCPCS C-codes
for Medicare Use
Page 5
Answer to Clinical Example 6: Chemotherapy Infusion with Anti-Emetics
Chemo Regimen
Service Time Explanation 2006 Codes 2006 Codes
IVP 10:00 - 10:10Decadron/Aloxi (non-chemo)
90775 x 1C8952 x 1
IVP 10:10 - 10:20 Reglan (non-chemo) 90775 x 1 C8952 x 1
IV infusion 12:20 - 14:20 Cisplatin (chemo)
96413 x 1 96415 x 1
C8954 x 1 C8955 x 1
2006 HCPCS C-codes for Medicare
Use
2006 CPT Codes for
Non-Medicare use
Page 6
Answer to Clinical Example 7: Chemotherapy Infusion with Anti-Emetics, Pre-and-
Post Hydration, and Additional Meds
Chemo Regimen
Service Time Explanation 2006 Codes 2006 Codes
IVP 10:00 - 10:10Decadron/Aloxi (non-chemo)
90775 x 1C8952 x 1
IVP 10:10 - 10:20 Reglan (non-chemo) 90775 x 1 C8952 x 1
IV infusion 10:20 - 12:20 Hydration90761 x 2 C8950 x 1
C8951 x 1
IV infusion 12:20 - 14:20 Cisplatin (chemo)96413 x 1 96415 x 1
C8954 x 1 C8955 x 1
IVP 14:20 - 14:55 Mannitol (non-chemo) 90775 x 1 C8952 x 1
IV infusion 14:55 - 16:55 Hydration 90761 x 2 C8951 x 2
IV infusion 16:55 - 17:55 Etoposide (chemo) 96417 x 1 C8955 x 1
IVP 17:55 - 18:05 Bleomyocin (chemo) 96411 x 1 C8953 x 1
2006 CPT Codes for non-Medicare use
2006 C-codes for Medicare
Use
Page 7
Answer to Clinical Example 8: Concept of Sequential Drug Administration as Presented at the CPT Symposium in Chicago
Chemo Regimen
Service Time Explanation2006 CPT
Codes 2006 C-CodesIVP 9:00-9:20 Ativan (non-chemo) 90775 x 1 C8952 x 1
IVPB 9:25-9:45 Decadron, Zofran, Benadryl (non-chemo)
90767 x 1 C8950 x 1
IV Infusion 9:45-10:45 Paraplatin (chemo) 96413 x 1 C8954 x 1
IV Infusion 10:45-11:15 Cytoxan (chemo) 96417 x 1 N/A
2006 CPT Codes for non-Medicare use
2006 HCPCS C-Codes for
Medicare Use
Note: There is no sequential chemotherapy infusion C-code available to report to Medicare. Also, the total time of the Paraplatin and Cytoxan does not meet the time requirement to bill any additional hours using the C8955 add-on code. Page 8
Service Time Explanation 2006 CPT Codes 2006 codes
IVP 13:15 (15 min) Zofran (non-chemo) 90775 x 1 C8952 x 1
90761 x 1 C8950 X 1
IVP 13:25 - 13:55 Adriamycin (chemo) 96411 x 1 C8953 x 1
IV infusion 14:00 - 15:30 Cytoxan (chemo) 96413 x 1 C8954 x 1
IV infusion 15:30 - 16:30 Taxotere (chemo) 96417 x 1 C8955 x 1
Codes/units if overlapping time for Cytoxan and Taxotere is deducted (hydration then = 45 minutes)
2006 HCPCS C-codes for
Medicare Use
IV infusion 13:15 - 16:45 Hydration90761 x 3 OR see below
C8950 x 1 C8951 x 2 or see below
Chemo Regimen w/ hydration hour overlapping with Chemo Infusion
2006 CPT Codes for non-Medicare use
Answer for Clinical Example 9: Chemotherapy Infusion and Hydration with Overlapping Time
Since the hydration runs throughout the course of the chemotherapy infusion, many hospitals are only reporting the non-overlapping hydration time and not the overlapping time (i.e., not the full duration of the hydration if it overlaps). Please request clarification from your FI and/or CMS. Page 9
Answer to Clinical Example # 10: Concept of Concurrent Infusions Under CPT
Codes vs. Medicare C-Codes
Service Time Explanation 2006 CPT Codes 2006 Codes
Chemotherapy drug injection 12:10 Fluorouracil given by the hospital as an IVP
96411 x 1 C8953 x 1
96413 x 1 96415 x 1
C8954 x 1 C8955 x 1
90768 x 1 C8950 x 1 C8951 x 1
SAMPLE FOLFOX REGIMEN
Non-chemotherapy drug infusion
10:00 to 12:00
The non-chemo drug Leucovorin is infused concurrently with the chemo drug Oxaliplatin through "Y" tubing. Order reads: Leucovorin 200mg/m2 IVPB run in 2 hrs.mg/m2 IVPB Run in 2 hrs.
2006 CPT Codes for non-Medicare
use
2006 HCPCS C-codes for
Medicare Use
Chemotherapy drug infusion
10:00 to 12:00
The drug Oxaliplatin is infused concurrently with the non-chemo Leucovorin drug through "Y" tubing. Oxaliplatin is compatible with Leucovorin, but not the second chemo drug Fluorouracil. Order reads: Oxaliplatin 85mg/m2 IVPB Run in 2 hrs.
There is no concurrent infusion C-code for Medicare. However, in this example, two different types of services are running concurrently (chemo and non-chemo). We believe Transmittal 785 allows for both of these services to be reported. The concept of “concurrent” is not well-defined, therefore hospitals should request clarification from their FI and/or CMS to determine how they will report this. We have requested official guidance but have not received a response as of Feb 3, 2006. Page 10