Here is a clinical scenario that will help demonstrate the correct usage of the chemotherapy CPT codes in conjunction with the therapeutic CPT codes.
Patient presents to the chemotherapy OP department for an IV infusion of Cytoxan. The chemo IV infusion is documented as having been infused for one (1) hour. Prior to the chemotherapy infusion, the patient also received an IV infusion of Zofran (anti-emetic) for the prevention of nausea and vomiting. Nursing has documented the therapeutic infusion as having been infused for one (1) hour per start and stop times. This would be reported as:
96413 (chemotherapy administration, IV infusion technique; up to 1 hour, single or initial drug) for the Cytoxan chemo infusion AND
90766 (IV infusion, for therapy, prophylaxis, or diagnosis; each additional hour) for the therapeutic IV infusion of Zofran
If the chemo was actually infused longer than one (1) hour, you would report the additional chemotherapy hours with CPT code 96415 (chemotherapy administration, IV infusion technique; each additional hour, 1 to 8 hours) x the # of hours in addition to the “initial” chemotherapy CPT code of 96413.
If the drug administration of Zofran (anti-emetic) was given as an IVP, you would report this with CPT code 90775 (therapeutic, prophylactic or diagnostic injection; each additional sequential IVP of a new substance/drug) in addition to the “initial” chemotherapy CPT code of 96413.
Remember that the chemo IV infusion is considered the “initial” drug admin service according to the CPT hierarchy and any other drug admin services given either pre and/or post chemo, would be reported with the additional and/or subsequent CPT codes regardless of the ‘order’ in which they were given to the patient.