How To Use CPT Code 96413

CPT 96413 refers to the administration of chemotherapy via intravenous infusion for up to one hour, focusing on the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 96413?

CPT 96413 is a medical billing code used to describe the administration of chemotherapy drugs through intravenous infusion for a duration of up to one hour. This code is specific to the intravenous infusion technique and is utilized by medical professionals to accurately document and bill for this particular service.

2. 96413 CPT code description

The official description of CPT code 96413 is: “Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug.”

3. Procedure

The 96413 procedure involves the following steps:

1. Preparation of the chemotherapy drug(s) in the appropriate dosage and form.
2. Establishment of intravenous access, typically through a peripheral or central venous catheter.
3. Administration of the chemotherapy drug(s) via intravenous infusion, either as a single dose or as the initial substance in a series of infusions.
4. Monitoring of the patient throughout the infusion process to ensure proper drug delivery and to identify any potential adverse reactions.
5. Documentation of the procedure, including the specific drug(s) administered, dosage, duration of infusion, and any relevant patient observations or reactions.

4. Qualifying circumstances

Patients eligible to receive CPT code 96413 services are those diagnosed with cancer and prescribed chemotherapy treatment by their oncologist. The intravenous infusion technique must be deemed medically necessary and appropriate for the patient’s specific cancer type, stage, and overall health status. Additionally, the infusion must be administered for a duration of up to one hour to qualify for this specific code.

5. When to use CPT code 96413

It is appropriate to bill the 96413 CPT code when a patient receives chemotherapy administration via intravenous infusion for a duration of up to one hour. This code should be used for the initial or single substance/drug infusion, with additional codes utilized for subsequent infusions or other related services provided during the same encounter.

6. Documentation requirements

To support a claim for CPT 96413, the following information must be documented:

• Patient’s diagnosis and indication for chemotherapy treatment.
• Specific chemotherapy drug(s) administered, including the name, dosage, and route of administration.
• Duration of the intravenous infusion, which must be up to one hour.
• Any premedication or supportive care provided during the encounter.
• Patient’s response to the treatment, including any adverse reactions or complications.
• Details of any additional services provided during the encounter, such as hydration or additional drug infusions, with corresponding CPT codes.

7. Billing guidelines

When billing for CPT code 96413, it is essential to ensure that the documentation supports the medical necessity of the intravenous infusion technique and the specific chemotherapy drug(s) administered. Additionally, the infusion duration must be up to one hour, and any subsequent infusions or related services should be billed using the appropriate CPT codes. It is also crucial to verify payer-specific guidelines and requirements, as these may vary between insurance carriers.

8. Historical information

CPT 96413 was added to the Current Procedural Terminology system on January 1, 2006. There have been no significant updates to the code since its addition.

9. Similar codes to CPT 96413

Five similar codes to CPT 96413 include:

• CPT 96415: Chemotherapy administration via intravenous infusion for each additional hour beyond the initial hour.
• CPT 96416: Chemotherapy administration via intravenous infusion for a prolonged period, typically more than 8 hours.
• CPT 96417: Chemotherapy administration via intravenous infusion for each additional sequential infusion of a different drug.
• CPT 96409: Chemotherapy administration via intravenous push technique.
• CPT 96411: Chemotherapy administration via intravenous push technique for each additional drug.

10. Examples

Here are 10 detailed examples of CPT code 96413 procedures:

1. A patient with breast cancer receives an initial intravenous infusion of doxorubicin for 45 minutes.
2. A patient with lung cancer undergoes a 30-minute intravenous infusion of cisplatin as the first drug in a combination chemotherapy regimen.
3. A patient with colorectal cancer is administered a 60-minute intravenous infusion of oxaliplatin as a single-agent therapy.
4. A patient with ovarian cancer receives a 50-minute intravenous infusion of carboplatin as the initial drug in a multi-drug treatment plan.
5. A patient with leukemia undergoes a 40-minute intravenous infusion of cytarabine as part of their induction therapy.
6. A patient with lymphoma receives a 55-minute intravenous infusion of rituximab as a single-agent maintenance therapy.
7. A patient with multiple myeloma undergoes a 35-minute intravenous infusion of bortezomib as part of their treatment regimen.
8. A patient with pancreatic cancer receives a 60-minute intravenous infusion of gemcitabine as the first drug in a combination chemotherapy plan.
9. A patient with prostate cancer undergoes a 45-minute intravenous infusion of docetaxel as a single-agent therapy.
10. A patient with gastric cancer receives a 50-minute intravenous infusion of irinotecan as the initial drug in a multi-drug treatment plan.