Forum - Questions & Answers

Dec 22nd, 2009 - tracyc271 30 

Please help ASAP : )

Hello and Happy Holidays!!!

I have an patient in the hospital that has a ommaya reservoir and we need to access this for his chemotherapy today. My question is....


Can we bill for accessing an ommaya reservoir to draw cultures and/or administer chemo if they are in the hospital??

Also, does anyone know what the code is? I have found 96542, but that states injection- it isn't an injection so I am not sure??


Thanks for your help and have a great Holiday

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Dec 22nd, 2009 -

Please help ASAP :)

Look at 61107 (Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection) and see if that meets your needs.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com

Visit www.karenzupko.com for more information on national coding courses sponsored by AANS (neurosurgery/spine), AAOHNS (ent), ACS (surgery), ASPS (plastic surgery), SVS (vascular surgery), AAOS (orthopaedic surgery) and presented by KarenZupko & Associates,Inc.

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Dec 22nd, 2009 - tracyc271 30 

Please help ASAP!

Do you mean 61020? that meets your description?

It doesn't state anything about administration of substance like the 61026- The 61026 would be a better fit except for the "with injection" Does t his statement mean that it has to be an injection or is it just stating that we injecting meds? I am confused on the verbage I think with this one. His meds are about an hour long there for it isn't an injection but the way it is stated it sounds like it could be used, right?

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Dec 22nd, 2009 -

Please help ASAP :)

Yes -sorry my mistake. Hit send too soon. Look at 61026 - at least i got you to the right section of the CPT book! :)

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Dec 22nd, 2009 - tracyc271 30 

Please help ASAP!

Thank you so much! I am going to go with 61026- I was trying also one of the chemo therapy administration codes, but they are only for pleural cavity, peritoneal cavity or the CNS but INCLUDING thoracentesis, peritoneocentesis or spinal puncture so they won't work

Anyway, thank you so much for your help and I hope you have a great holiday! This website and the people on here are so helpful and great!

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Aug 24th, 2022 - cecdkc 1 

CAR-T administration through Ommaya Reservoir

I'm hoping someone can help with this question. If our provider administers CAR-T via the patient's Ommaya reservoir, would we bill 61026 and 0540T (plus the appropriate code for the biologic)? One of our providers codes with 61070 and I'm having a hard time figuring out what the difference is between the two codes in order to advise him. Thanks in advance for any help you can provide!

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Dec 22nd, 2009 - nmaguire   2,606 

96542

An Ommaya reservoir is a device that is surgically inserted under the scalp for direct injection of chemotherapy into the spinal fluid. When intrathecal chemotherapy is needed, an Ommaya allows drugs to be administered into the reservoir, rather than through the back during a spinal tap. Administering chemotherapy through an Ommaya is a sterile procedure, performed by a physician.
The Lab will bill the cultures.
The hospital bills the drugs.

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Dec 22nd, 2009 - tracyc271 30 

Please help ASAP!

Thank you for helping me with this, they sometimes want to bill for the most rediculous things....

I just received a second e-mail stating...

The hospital usually bills for chemo admin, blood draws etc, however hospital staff can't access an ommaya reservoir. (not trained to, and high risk) so how do we bill for the access of the reservoir?

I thought it would be 96542- Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents. But we are not giving the drugs, the hospital is, the NP covering the hospital under our service, Hem/Onc, wants to bill for the access of the reservoir, I don't think that is something that can be billed, let alone seperately, can it?

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Dec 22nd, 2009 -

Please help ASAP :)

The provider who performs the Ommaya reservoir injection reports 61026. This may be a physician, NP (if in their scope of practice) or PA (again, if scope of practice allows).

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