Oncology Coding: Figure Out The Proper Adverse Reaction Code

By Author: Nancy Rose
Total Articles: 53
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See to it that you describe all the circumstances surrounding a push to get complete reimbursement.

Question: Should I report a push if a non-Hodgkin's lymphoma patient has an adverse reaction to Rituximab less than 15 minutes into the ordered hour-long infusion?


Answer: According to experts, the correct way to report a discontinued infusion is to use modifier 53 (discontinued procedure) to the right chemotherapy infusion code like 96413 (Chemotherapy administration, intravenous infusion technique; up to one hour, single or for that matter initial substance/drug).


You should add modifier 53 when a physician stops a procedure because of extenuating circumstances or those that threaten the welfare of the patient, according to CPT.


Modifier 53 describes an unexpected problem, away from the physician's or patient's control, that calls for ending the procedure. The doctor does not choose to discontinue the procedure as much as he's forced to do ...
... so owing to the circumstances.


Push: CPT guidelines cover an infusion of 15 minutes or less" as one definition of a push; however 96413-53 describes the ordered and provided service more precisely than a push code ( like 96409, Chemotherapy administration; intravenous, push technique, single or initial substance/drug).


HCPCS: Your documentation should talk about the circumstances, the administration start and stop times, and the amount of drug delivered and discarded. If you are coding for the drug (J9310, Injection, rituximab, 100 mg), you should be able to report the entire amount, provided you discarded the amount not administered.


ICD-9: Also remember to report the right ICD-9 codes like V58.12 (Encounter for antineoplastic immunotherapy) and 202.8x (Other lymphomas), and a code to show why the procedure stopped, say for instance V64.1 (Surgical or other procedure not carried out because of contraindication) or E933.1 (Drugs, medicinal, and biological substances causing undesirable effects in therapeutic use; antineoplastic and immunosuppressive drugs).


What's more, watch for E/M services carried out to care for the patient.