Chemotherapy Billing

New to chemotherapy billing and would love some clarification and or guidance. We've been instructed to submit first initial code, and subsequent admin codes with a 59 modifier, ie 96413, 96415.59,96417.59. Any suggestions or comments or proper coding?

infusion therapy

It is not necessary to use the -59 modifier with subsequent hours of infusion / chemotherapy. 96413 is the initial hour, 96415 is subsequent. A -59 modifier signifies separate procedure. This is not a separate procedure, it is subsequent to the initial procedure. Specifically, 96413 states:

"Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug. 96415 [states:] each additional hour (List separately in addition to code for prinary procedure) INCLUDES: infusion intervals of more than 30 minutes past 1-hour increments. Code first initial hour 96413. (AMA, 2008, pp 439-440). "

AMA. (2008). Current Procedural Coding Expert. American Medical Association. Salt Lake City: Ingenix.

Chemotherapy billing

Thank you for your reply! So in your opinion it would be safe to say we are just adding add'l data entry, not necessary errouneously billing?

Chemotherapy billing

It is not necessary to use the modifier, in fact, I would venture to say that it is wrong to use the modifier and may cause more problems for you. I'm wondering who would tell you to do that; it's not correct according to the semantics of coding and it is not correct in terms of workarounds for reimbursement, either.

Chemo billing/59 Mod

Hello- I just wanted to add that we were told that for all additional therapy other than the initial we had to add a 59mod for just once certain carrier or it wasn't going to be paid. Being a coder and a person that reviews the infusion here, I had a real hard time with this and had meeting after meeting with this particular carrier! After 7 months of adding the 59mod just for this carrier and meeting with them once a month, they finally dropped this rule. For additional therapy in Chemo, 59 modifier is not needed! Just becareful, all carriers, other than Medicare/Medicaid, will try to have you do some funky things!!!