How To Use CPT Code 96423

CPT 96423 describes the administration of chemotherapy through an intra-arterial infusion technique, specifically for each additional hour beyond the first hour. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96423?

CPT 96423 can be used to describe the administration of chemotherapy drugs through an intra-arterial infusion technique for each additional hour beyond the initial hour. This code is used when the provider delivers the chemotherapeutic agent slowly into the port of the catheter placed in the artery leading directly to the target treatment area. It is important to note that CPT 96423 is an add-on code and should be reported in conjunction with the primary code, CPT 96422, for the first hour of infusion.

2. Official Description

The official description of CPT code 96423 is: ‘Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure).’ It is important to remember that this code should only be reported for infusion intervals of greater than 30 minutes beyond 1-hour increments. For regional chemotherapy perfusion via a membrane oxygenator perfusion pump to an extremity, CPT code 36823 should be used instead.

3. Procedure

1. In this procedure, the provider administers the chemotherapy drug into an artery using an intra-arterial infusion technique.
2. The provider first places a catheter in the artery leading directly to the target treatment area.
3. Once the catheter is in place, the provider delivers the chemotherapeutic drug slowly into the port of the catheter.
4. This technique allows the drug to reach the target area immediately, as the catheter is placed in the artery that directly feeds the tumor.
5. CPT 96423 is used to report each additional hour of intra-arterial drug infusion time beyond the initial hour.

4. Qualifying circumstances

CPT 96423 is used when the provider administers chemotherapy through an intra-arterial infusion technique for each additional hour beyond the first hour. This procedure is typically performed on patients with cancer or other diseases that require the direct delivery of chemotherapy drugs to the target treatment area. It is important to note that CPT 96423 should only be reported if the infusion intervals are greater than 30 minutes beyond 1-hour increments.

5. When to use CPT code 96423

CPT code 96423 should be used when the provider administers chemotherapy drugs through an intra-arterial infusion technique for each additional hour beyond the initial hour. It is important to report this code in conjunction with the primary code, CPT 96422, for the first hour of infusion. This code should not be reported without an appropriate primary code, as payers may not reimburse for CPT 96423 alone.

6. Documentation requirements

To support a claim for CPT 96423, the provider must document the following information:

• The need for intra-arterial chemotherapy administration
• The specific chemotherapeutic agent used
• The start and end time of each additional hour of infusion
• The total duration of the infusion beyond the initial hour
• Any complications or adverse reactions during the infusion
• The signature of the provider administering the chemotherapy

7. Billing guidelines

When billing for CPT 96423, ensure that the provider administers the chemotherapy drugs through an intra-arterial infusion technique for each additional hour beyond the initial hour. It is important to report this code in conjunction with the primary code, CPT 96422, for the first hour of infusion. Additionally, consider the guidelines provided by payers regarding the reporting of CPT 96423 with other codes. It is crucial to follow these guidelines to ensure proper reimbursement.

8. Historical information

CPT 96423 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been historical changes to the code. On January 1, 2006, the code description was updated to include the range of one to eight hours for infusion technique, each additional hour. On January 1, 2007, the code description was further revised to specify the range of up to eight hours for infusion technique, each additional hour.

9. Examples

1. A provider administers chemotherapy drugs through an intra-arterial infusion technique for two additional hours beyond the initial hour to a patient with liver cancer.
2. During a treatment session, a provider delivers chemotherapy drugs through an intra-arterial infusion technique for three additional hours beyond the initial hour to a patient with pancreatic cancer.
3. A provider administers chemotherapy drugs through an intra-arterial infusion technique for four additional hours beyond the initial hour to a patient with lung cancer.
4. For a patient with breast cancer, a provider administers chemotherapy drugs through an intra-arterial infusion technique for five additional hours beyond the initial hour during a treatment session.
5. A provider delivers chemotherapy drugs through an intra-arterial infusion technique for six additional hours beyond the initial hour to a patient with colorectal cancer.
6. During a treatment session, a provider administers chemotherapy drugs through an intra-arterial infusion technique for seven additional hours beyond the initial hour to a patient with ovarian cancer.
7. A provider administers chemotherapy drugs through an intra-arterial infusion technique for eight additional hours beyond the initial hour to a patient with lymphoma.
8. For a patient with leukemia, a provider delivers chemotherapy drugs through an intra-arterial infusion technique for nine additional hours beyond the initial hour during a treatment session.