How To Use CPT Code 96402

CPT 96402 refers to the administration of chemotherapy, either subcutaneously or intramuscularly, using a hormonal anti-neoplastic drug. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96402 procedures.

1. What is CPT 96402?

CPT 96402 is a medical billing code used to describe the administration of chemotherapy through subcutaneous or intramuscular injections, specifically using a hormonal anti-neoplastic drug. This code is utilized when a healthcare provider administers chemotherapy to treat hormone-sensitive tumors or neoplasms, which are uncontrolled growths or tumors in the body.

2. 96402 CPT code description

The official description of CPT code 96402 is: “Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic.”

3. Procedure

The 96402 procedure involves the following steps:

1. Assessment of the patient’s medical history, current condition, and any contraindications to the hormonal anti-neoplastic drug.
2. Preparation of the chemotherapy drug, ensuring the correct dosage and formulation.
3. Selection of the appropriate injection site, either subcutaneous or intramuscular, based on the drug’s properties and the patient’s condition.
4. Administration of the chemotherapy drug using a sterile needle and syringe.
5. Monitoring the patient for any adverse reactions or complications during and after the injection.
6. Documentation of the procedure, including the drug used, dosage, route of administration, and any relevant observations.

4. Qualifying circumstances

Patients eligible to receive CPT code 96402 services are those diagnosed with hormone-sensitive tumors or neoplasms that require treatment with hormonal anti-neoplastic drugs. These patients must have a documented medical need for chemotherapy and have no contraindications to the specific drug being administered. Additionally, the healthcare provider must determine that the subcutaneous or intramuscular route of administration is the most appropriate method for the patient’s condition and the drug being used.

5. When to use CPT code 96402

It is appropriate to bill the 96402 CPT code when a healthcare provider administers a hormonal anti-neoplastic drug via subcutaneous or intramuscular injection to treat a hormone-sensitive tumor or neoplasm. The provider must ensure that the patient meets the qualifying circumstances and that the procedure is medically necessary and supported by appropriate documentation.

6. Documentation requirements

To support a claim for CPT 96402, the following information must be documented:

• Patient’s medical history and current condition, including the diagnosis of a hormone-sensitive tumor or neoplasm.
• Indication of the specific hormonal anti-neoplastic drug used, including the drug’s name, dosage, and formulation.
• Route of administration (subcutaneous or intramuscular) and the injection site.
• Date and time of the procedure.
• Any relevant observations, such as the patient’s response to the treatment or any adverse reactions.
• Provider’s signature and credentials.

7. Billing guidelines

When billing for CPT code 96402, it is essential to follow the appropriate guidelines and rules. These include ensuring that the patient meets the qualifying circumstances, the procedure is medically necessary, and the documentation requirements are met. Additionally, it is crucial to verify any payer-specific rules or guidelines, as these may vary between insurance companies. Providers should also be aware of any relevant modifiers, such as those indicating the specific drug used or the presence of complications, and apply them as needed.

8. Historical information

CPT 96402 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Similar codes to CPT 96402

Five similar codes to CPT 96402 and how they differ are:

1. CPT 96401: This code is used for the administration of non-hormonal anti-neoplastic chemotherapy drugs via subcutaneous or intramuscular injection.
2. CPT 96409: This code refers to the intravenous administration of chemotherapy drugs, rather than subcutaneous or intramuscular injections.
3. CPT 96413: This code is used for the administration of chemotherapy drugs via a continuous intravenous infusion lasting up to one hour.
4. CPT 96415: This code is for the administration of additional chemotherapy drugs via continuous intravenous infusion, each additional hour.
5. CPT 96416: This code is for the initiation of a prolonged chemotherapy infusion, lasting more than eight hours, and requiring the use of a portable or implantable pump.

10. Examples

Here are 10 detailed examples of CPT code 96402 procedures:

1. A patient with breast cancer receives a subcutaneous injection of a hormonal anti-neoplastic drug to treat their hormone-sensitive tumor.
2. A patient with prostate cancer is administered an intramuscular injection of a hormonal anti-neoplastic drug as part of their chemotherapy treatment plan.
3. A patient with endometrial cancer receives a subcutaneous injection of a hormonal anti-neoplastic drug to shrink their tumor before surgery.
4. A patient with ovarian cancer is treated with an intramuscular injection of a hormonal anti-neoplastic drug as part of their chemotherapy regimen.
5. A patient with a hormone-sensitive brain tumor receives a subcutaneous injection of a hormonal anti-neoplastic drug to slow the tumor’s growth.
6. A patient with a hormone-sensitive lung tumor is administered an intramuscular injection of a hormonal anti-neoplastic drug as part of their chemotherapy treatment.
7. A patient with a hormone-sensitive bone tumor receives a subcutaneous injection of a hormonal anti-neoplastic drug to help control the tumor’s growth.
8. A patient with a hormone-sensitive liver tumor is treated with an intramuscular injection of a hormonal anti-neoplastic drug as part of their chemotherapy regimen.
9. A patient with a hormone-sensitive kidney tumor receives a subcutaneous injection of a hormonal anti-neoplastic drug to help shrink the tumor before surgery.
10. A patient with a hormone-sensitive skin tumor is administered an intramuscular injection of a hormonal anti-neoplastic drug as part of their chemotherapy treatment plan.