Applying CPT and HCPCS C-Codes and Rules for Drug Administration Services to Clinical Scenarios

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 2006 CPT Codes for non- Medicare use 2006 HCPCS C- codes for Medicare Use Service Time Explanation 2006 Codes 2006 Codes IVP 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 Page 1

Answer for Clinical Example 2: Emergency Department and Observation Visit for a Gastric Ulcer Patient ED and Observation Example 2006 CPT Codes for non- Medicare use 2006 HCPCS C- codes for Medicare Use Service Time Explanation 2006 Codes 2006 Codes IVP 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 Observation 14:30-16:30 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 Page 2

Answer for Clinical Example 3: Multiple Push Injections of the Same Drug Chemo Regimen 2005 Hospital Reporting 2005 CPT 2006 C- Service Time Explanation Codes 2006 CPT Codes 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 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 2006 CPT Codes Service Time Explanation for non- Medicare use 2006 C-Codes for Medicare Use IVPB 1000-1100 Antibiotic 1 90765 x 1 C8950 x1 IVPB 1000-1100 Antibiotic 2 90768 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 Page 4 both the antibiotic and the chemo infusion.

Answer for Clinical Example 5: Two Chemotherapy Push Drugs with a Non-Chemotherapy Drug 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 Service Time Explanation 2006 Codes 2006 codes IVP 9:00 PS-341 (chemo) 96409 x 1 C8953 x 1 IVP 10:02 5FU (chemo) 96411 x 1 C8953 x 1 IVP 9:30 Leucovorin (nonchemo) 90775 x 1 C8952 x 1 Page 5

Answer to Clinical Example 6: Chemotherapy Infusion with Anti-Emetics Chemo Regimen 2006 CPT Codes for Non-Medicare use 2006 HCPCS C-codes for Medicare Use Service Time Explanation 2006 Codes 2006 Codes Decadron/Aloxi (nonchemo) C8952 x 90775 x 1 IVP 10:00-10:10 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 Page 6

Answer to Clinical Example 7: Chemotherapy Infusion with Anti-Emetics, Pre-and- Post Hydration, and Additional Meds Chemo Regimen 2006 CPT Codes for non- Medicare use 2006 C-codes for Medicare Use Service Time Explanation 2006 Codes 2006 Codes Decadron/Aloxi (nonchemo) C8952 x 90775 x 1 IVP 10:00-10:10 1 IVP 10:10-10:20 Reglan (non-chemo) 90775 x 1 C8952 x 1 IV infusion 10:20-12:20 Hydration 90761 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 Page 7

Answer to Clinical Example 8: Concept of Sequential Drug Administration as Presented at the CPT Symposium in Chicago Chemo Regimen 2006 CPT Codes for non- Medicare use 2006 HCPCS C- Codes for Medicare Use 2006 CPT Service Time Explanation Codes 2006 C-Codes IVP 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 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

Answer for Clinical Example 9: Chemotherapy Infusion and Hydration with Overlapping Time Chemo Regimen w/ hydration hour overlapping with Chemo Infusion 2006 CPT Codes for non-medicare use 2006 HCPCS C-codes for Medicare Use Service Time Explanation 2006 CPT Codes 2006 codes IVP 13:15 (15 min) Zofran (non-chemo) 90775 x 1 C8952 x 1 IV infusion 13:15-16:45 Hydration 90761 x 3 OR see below C8950 x 1 C8951 x 2 or see below Codes/units if overlapping time for Cytoxan and Taxotere is deducted (hydration then = 45 minutes) 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 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 2006 CPT Codes 2006 HCPCS C- for non-medicare codes for use Medicare Use Service Time Explanation 2006 CPT Codes 2006 Codes SAMPLE FOLFOX REGIMEN 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. 96413 x 1 96415 x 1 C8954 x 1 C8955 x 1 Nonchemotherapy 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. 90768 x 1 C8950 x 1 C8951 x 1 Chemotherapy drug injection 12:10 Fluorouracil given by the hospital as an IVP 96411 x 1 C8953 x 1 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