How To Use CPT Code 96425

CPT 96425 describes the administration of chemotherapy using an intra-arterial infusion technique, specifically for the initiation of a prolonged infusion lasting more than 8 hours. 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 96425?

CPT 96425 is used to describe the administration of chemotherapy drugs through an intra-arterial infusion technique. This procedure involves delivering the chemotherapeutic agent directly into the artery leading to the target treatment area. The infusion is initiated using a portable or implantable pump, and the duration of the infusion lasts more than 8 hours. This code specifically represents the initiation of a prolonged infusion.

2. Official Description

The official description of CPT code 96425 is: ‘Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump.’

3. Procedure

1. The healthcare provider administers the chemotherapy drug into an artery using an infusion technique.
2. The infusion takes place through an implantable or portable pump.
3. The infusion lasts for more than 8 hours.
4. The provider sets the infusion pump to control the amount of drug delivered to the patient each hour.
5. The catheter used for infusion is placed in the artery leading directly to the target treatment area.
6. The advantage of this technique is that the drug reaches the target area immediately, as the catheter is placed in the artery that directly feeds the tumor.

4. Qualifying circumstances

CPT 96425 is used for patients who require chemotherapy treatment delivered through an intra-arterial infusion technique. This technique is specifically used for cases where a prolonged infusion lasting more than 8 hours is necessary. The use of a portable or implantable pump is required to deliver the chemotherapeutic drug slowly into the catheter. This code should only be used for the initiation of a prolonged infusion.

5. When to use CPT code 96425

CPT code 96425 should be used when a healthcare provider initiates a prolonged infusion of chemotherapy drugs using an intra-arterial infusion technique. This code is appropriate when the infusion lasts more than 8 hours and requires the use of a portable or implantable pump. It is important to note that this code represents the initiation of the infusion, not the refilling or maintenance of the pump.

6. Documentation requirements

To support a claim for CPT 96425, the healthcare provider must document the following information:

• The specific chemotherapy drug administered
• The need for intra-arterial infusion and the rationale for using this technique
• The duration of the infusion, which must be more than 8 hours
• The use of a portable or implantable pump
• The catheter placement and target treatment area
• The start and end time of the infusion
• The amount of drug delivered to the patient each hour
• Any complications or adverse reactions during the infusion
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 96425, ensure that the procedure meets the qualifying circumstances, including the use of a portable or implantable pump and a prolonged infusion lasting more than 8 hours. It is important to note that CPT code 96425 should not be reported if the refilling or maintenance of the pump is performed. Additionally, consider the location of the testing when coding for pulmonary function tests, as they have both a professional and technical component.

8. Historical information

CPT 96425 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider initiates a prolonged infusion of chemotherapy drugs using an intra-arterial infusion technique for a patient with liver cancer.
2. A patient with pancreatic cancer receives a prolonged infusion of chemotherapy drugs through an intra-arterial infusion technique using a portable pump.
3. A healthcare provider administers a prolonged infusion of chemotherapy drugs through an intra-arterial infusion technique for a patient with head and neck cancer.
4. A patient with colorectal cancer undergoes a prolonged infusion of chemotherapy drugs using an intra-arterial infusion technique with the help of an implantable pump.
5. A healthcare provider initiates a prolonged infusion of chemotherapy drugs through an intra-arterial infusion technique for a patient with breast cancer.
6. A patient with lung cancer receives a prolonged infusion of chemotherapy drugs using an intra-arterial infusion technique with the assistance of a portable pump.
7. A healthcare provider administers a prolonged infusion of chemotherapy drugs through an intra-arterial infusion technique for a patient with bladder cancer.
8. A patient with ovarian cancer undergoes a prolonged infusion of chemotherapy drugs using an intra-arterial infusion technique with the use of an implantable pump.
9. A healthcare provider initiates a prolonged infusion of chemotherapy drugs through an intra-arterial infusion technique for a patient with lymphoma.
10. A patient with leukemia receives a prolonged infusion of chemotherapy drugs using an intra-arterial infusion technique with the help of a portable pump.