How To Use CPT Code 96450

CPT 96450 describes the administration of chemotherapy into the patient’s central nervous system (CNS), specifically the spinal cord. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96450?

CPT 96450 can be used to describe the administration of chemotherapy into the patient’s central nervous system, specifically the spinal cord. This procedure involves a spinal puncture, where a needle is inserted into the spinal canal in the lumbar region of the back. The code covers both the administration of the chemotherapy drug and the spinal puncture involved.

2. Official Description

The official description of CPT code 96450 is: ‘Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture.’

3. Procedure

1. The healthcare provider administers chemotherapy directly into the patient’s central nervous system, specifically the spinal cord.
2. This procedure involves a spinal puncture, where a needle is inserted into the spinal canal in the lumbar region of the back.
3. The chemotherapy drug is infused into the space that contains cerebrospinal fluid.
4. The procedure may be performed by an oncologist or another physician.
5. If another physician performs the spinal puncture, the oncologist should append modifier 52 (Reduced services) to CPT 96450, and the other physician should report the spinal puncture services separately.

4. Qualifying circumstances

CPT 96450 is used for patients who require chemotherapy administration into the central nervous system. This procedure is typically performed for patients with tumors or other conditions affecting the CNS. It is important to note that the code covers both the administration of the chemotherapy drug and the spinal puncture involved.

5. When to use CPT code 96450

CPT code 96450 should be used when a healthcare provider administers chemotherapy directly into the patient’s central nervous system, specifically the spinal cord. It is important to ensure that the procedure includes a spinal puncture. If the spinal puncture is not performed, a different code should be used to report the administration of chemotherapy.

6. Documentation requirements

To support a claim for CPT 96450, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for chemotherapy administration into the CNS
• Date of the procedure
• Start and end time of the procedure
• Details of the chemotherapy drug administered
• Documentation of the spinal puncture, including the technique used
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 96450, ensure that the procedure includes both the administration of chemotherapy and the spinal puncture. If another physician performs the spinal puncture, the oncologist should append modifier 52 to CPT 96450, and the other physician should report the spinal puncture services separately. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 96450 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2002, where the description was updated to include the term “lumbar puncture” instead of “spinal puncture.”

9. Examples

1. An oncologist performs a spinal puncture to administer chemotherapy directly into a spinal tumor.
2. A patient with leukemia receives chemotherapy administered into the CNS through a spinal puncture.
3. A healthcare provider administers chemotherapy into the CNS of a patient with lymphoma.
4. A neurosurgeon performs a spinal puncture to deliver chemotherapy directly into the spinal cord of a patient with a CNS tumor.
5. A patient with metastatic cancer receives chemotherapy administered into the CNS through a spinal puncture.
6. A pediatric oncologist administers chemotherapy into the CNS of a child with a brain tumor through a spinal puncture.
7. A patient with spinal metastases receives chemotherapy directly into the CNS through a spinal puncture.
8. An oncology nurse assists in the administration of chemotherapy into the CNS of a patient with a CNS tumor through a spinal puncture.
9. A healthcare provider performs a spinal puncture to deliver chemotherapy directly into the spinal cord of a patient with a CNS lymphoma.
10. A patient with a spinal cord tumor receives chemotherapy administered into the CNS through a spinal puncture.