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An intravenous infusion of a chemotherapy substance or drug is a critical procedure used in the treatment of malignant neoplasms, which are cancers that can invade surrounding tissues and spread to other parts of the body. During this procedure, a healthcare professional places an intravenous (IV) line into a vein, typically located in the patient's arm, to facilitate the delivery of the chemotherapy agent directly into the bloodstream. This method allows for the rapid distribution of the drug throughout the body, targeting cancer cells effectively. The administration of chemotherapy requires the physician to provide direct supervision, ensuring that they are immediately available to address any complications that may arise during the infusion. Additionally, the physician conducts periodic assessments of the patient’s condition and documents the patient's response to the treatment, which is essential for monitoring efficacy and adjusting future treatment plans as necessary. For coding purposes, the specific CPT® code 96413 is utilized for the administration of a single or initial chemotherapy substance or drug via intravenous infusion lasting up to one hour. This code is part of a broader coding framework that includes additional codes for extended infusions and sequential infusions of different substances or drugs.
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The intravenous infusion of chemotherapy is indicated for the treatment of malignant neoplasms. This procedure is typically performed when a patient has been diagnosed with cancer and requires systemic therapy to target and destroy cancer cells. The specific indications for this procedure may include:
The procedure for administering chemotherapy via intravenous infusion involves several critical steps to ensure safety and efficacy. The following outlines the procedural steps:
After the chemotherapy infusion is completed, the healthcare team continues to monitor the patient for any delayed reactions or side effects that may occur. The IV line is removed, and the site is assessed for any signs of complications, such as infection or phlebitis. Patients are often provided with post-infusion care instructions, which may include information on managing side effects, signs of complications to watch for, and follow-up appointments for further treatment or assessments. It is essential for patients to report any unusual symptoms or concerns to their healthcare provider promptly.
| Short Descr | CHEMO IV INFUSION 1 HR | Medium Descr | CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG | Long Descr | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 1 | CCS Clinical Classification | 224 - Cancer chemotherapy |
This is a primary code that can be used with these additional add-on codes.
| 0663T | Add-on Code MPFS Status: Carrier Priced APC N Scalp cooling, mechanical; placement of device, monitoring, and removal of device (List separately in addition to code for primary procedure) | 96361 | Addon Code MPFS Status: Active Code APC S CPT Assistant Article Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) | 96366 | Addon Code MPFS Status: Active Code APC S CPT Assistant Article Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) | 96367 | Addon Code MPFS Status: Active Code APC S CPT Assistant Article Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure) | 96368 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) | 96375 | Addon Code MPFS Status: Active Code APC S CPT Assistant Article Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) | 96376 | Addon Code MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC N CPT Assistant Article 1Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) | 96411 | Addon Code MPFS Status: Active Code APC S Physician Quality Reporting PUB 100 CPT Assistant Article Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure) | 96415 | Addon Code MPFS Status: Active Code APC S Physician Quality Reporting PUB 100 CPT Assistant Article Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) | 96417 | Addon Code MPFS Status: Active Code APC S Physician Quality Reporting PUB 100 CPT Assistant Article Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | GA | Waiver of liability statement issued as required by payer policy, individual case | KX | Requirements specified in the medical policy have been met | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | CR | Catastrophe/disaster related | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GW | Service not related to the hospice patient's terminal condition | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | JZ | Zero drug amount discarded/not administered to any patient | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | JA | Administered intravenously | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AG | Primary physician | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | HO | Masters degree level | JW | Drug amount discarded/not administered to any patient | KO | Single drug unit dose formulation | LT | Left side (used to identify procedures performed on the left side of the body) | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | SA | Nurse practitioner rendering service in collaboration with a physician | SU | Procedure performed in physician's office (to denote use of facility and equipment) | TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care |
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| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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