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Drug Administration Coding – 2006 Update

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This article was revised on November 16, 2006, to include HCPCS code Q4079 (Natalizumab, 1 mg) under Monoclonal Antibodies. All other information remains the same.

Empire Medicare Services has received inquiries regarding the correct billing of the drug administration codes when more than one administration code is billed for a beneficiary on the same date of service.

The administration codes are divided into three groups by the type of drug or fluid administered:

Hydration (90760, 90761)
Therapeutic, Prophylactic, and Diagnostic (90765-90779)
Chemotherapy (96401-96549)

The chemotherapy administration codes are also used to bill the administration of monoclonal antibodies and biologic response modifiers, in addition to non-radionuclide anti-neoplastic drugs (refer to attached chart, “Drugs Billed Using Chemotherapy Administration Codes”).

When billing for multiple intravenous injections or infusions, providers should bill only one “initial” administration service unless an established protocol requires the use of two separate intravenous sites. Additional intravenous drug administration should be billed using sequential or “each additional” or concurrent administration codes (concurrent infusion may be billed only once per encounter). These subsequent administration services are listed as “add-on” codes in CPT. (Note: 90766 can be an add-on code to 90767, but the 90767 must also be billed with a base code of its own on the same claim. Similarly, 96415 can be an add-on to 96417 but 96417 also requires its own base code.)

The “initial” administration code billed should be the one that is associated with the principal reason for the encounter. If a patient is being treated with a chemotherapeutic drug, then it is assumed that chemotherapy is the principal reason for the encounter. Therefore, drug administration codes from the diagnostic/therapeutic group and the hydration group should not be billed as the initial service. All other intravenous drugs should be billed using subsequent or “each additional” codes.

Each add-on code must have an appropriate initial or base code billed on the same claim.

The following table contains appropriate base and add-on code pairings:

Add-on Code	Base Code
90761	90760, 90765, 90774, 96409, 96413, 96416
90766	90760, 90765, 90767
90767	90760, 90765, 90774, 96409, 96413, 96416
90768	90760, 90765, 90767, 96413, 96416
90775	90760, 90765, 90774, 96409, 96413, 96416
96411	96409, 96413, 96416
96415	96413, 96417
96417	96409, 96413, 96416

Drugs Billed Using Chemotherapy Administration Codes

Biologic Response Modifiers		Hormonal Antineoplastics
J0128	Aberelix 10 mg	J0970	Estradiol valerate up to 40 mg
J0215	Alefacept 0.5 mg	J1000	Depo-estradiol cypionate up to 5 mg
J1440	Filgrastim 300 mcg	J1380	Estradiol valerate 10 mg
J1441	Filgrastim 480 mcg	J1390	Estradiol valerate 20 mg
J2355	Oprelvekin 5 mg	J1410	Estrogen conjugate 25 mg
J2425	Palifermin 50 mcg	J1435	Estrone 1 mg
J2505	Pegfilgrastim 6 mg	J3315	Triptorelin pamoate 3.75 mg
J2820	Sargramostim 50 mcg	J9165	Diethylstilbestrol 250 mg
J7511	Antithymocyte globulin rabbit 25 mg	J9202	Goserelin acetate implant per 3.6 mg
J7516	Cyclosporin parenteral 250 mg	J9217	Leuprolide acetate suspension 7.5 mg
J7525	Tacrolimus 5 mg	J9219	Leuprolide acetate implant 65 mg
J9015	Aldesleukin/single use vial	J9225	Histrelin implant 50 mg
J9031	Bcg live intravesical per instillation	J9395	Fulvestrant 25 mg
J9213	Interferon alfa-2a 3 million units
J9214	Interferon alfa-2b 1 million units
J9215	Interferon alfa-n3 250,000 IU
Q3025	Interferon beta 1-a 11 mcg IM

Monoclonal Antibodies		Monoclonal Antibodies
J0130	Abciximab 10 mg	J7513	Dacililzumab, parenteral 25 mg
J0480	Basiliximab 20 mg	J9010	Alemtuzumab 10 mg
J1162	Digoxin immune fab (ovine) per vial	J9035	Bevacizumab 10 mg
J1745	Infliximab 10 mg	J9041	Bortezomib 0.1 mg
J2357	Omalizumab 5 mg	J9055	Cetuximab 10 mg
J2503	Pegaptanib sodium 0.3 mg	J9310	Rituximab 100 mg
		J9355	Trastuzumab 10 mg
		Q4079	Natalizumab, 1 mg
Chemotherapy Drugs		Chemotherapy Drugs
J9000	Doxorubicin HCI 10 mg	J9181	Etoposide 10 mg
J9001	Doxorubicin HCI liposome 10 mg	J9182	Etoposide 100 mg
J9017	Arsenic trioxide 1 mg	J9185	Fludarabine phosphate 50 mg
J9020	Asparaginase 10,000 units	J9190	Fluorouracil 500 mg
J9025	Azacitidine 1 mg	J9200	Floxuridine 500 mg
J9027	Clofarabine 1 mg	J9201	Gemcitabine HCI 200 mg
		J9206	Irinotecan 20 mg
J9040	Bleomycin sulfate 15 units	J9208	Ifosamide 1 g
J9045	Carboplatin 50 mg	J9211	Idarubicin HCI 5 mg
J9050	Carmustine 100 mg	J9230	Mechlorethamine HCI 10 mg
J9060	Cisplatin 10 mg	J9245	Melphalan HCI 50 mg
J9062	Cisplatin 50 mg	J9250	Methotrexate 5 mg
J9065	Cladribine 1 mg	J9260	Methotrexate 50 mg
J9070	Cyclophosphamide 100 mg	J9263	Oxaliplatin 0.5 mg
J9080	Cyclophosphamide 200 mg	J9265	Paclitaxel 30 mg
J9090	Cyclophosphamide 500 mg	J9266	Pegaspargase single dose vial
J9091	Cyclophosphamide 1 g	J9268	Pentostatin 10 mg
J9092	Cyclophosphamide 2 g	J9270	Plicamycin 2.5 mg
J9093	Cyclophosphamide lyophilized 100 mg	J9280	Mitomycin 5 mg
J9094	Cyclophosphamide lyophilized 200 mg	J9290	Mitomycin 20 mg
J9095	Cyclophosphamide lyophilized 500 mg	J9291	Mitomycin 40 mg
J9096	Cyclophosphamide lyophilized 1 g	J9293	Mitoxantrone HCI 5 mg
J9097	Cyclophosphamide lyophilized 2 g	J9300	Gemtuzumab ozogamicin 5 mg
J9098	Cytarabine liposome 10 mg	J9305	Pemetrexed 10 mg
J9100	Cytarabine 100 mg	J9320	Streptozocin 1 g
J9110	Cytarabine 500 mg	J9340	Thiotepa 15 mg
J9120	Dactinomycin 0.5 mg	J9350	Topotecan 4 mg
J9130	Dacarbazine 100 mg	J9357	Valrubicin 200 mg
J9140	Dacarbazine 200 mg	J9360	Vinblastine sulfate 1 mg
J9150	Daunorubicin HCI 10 mg	J9370	Vincristine sulfate 1 mg
J9151	Daunorubicin citrate liposomal 10 mg	J9375	Vincristine sulfate 2 mg
J9160	Denileukin diftitox 300 mcg	J9380	Vincristine sulfate 5 mg
J9170	Docetaxel 20 mg	J9390	Vinorelbine tartrate 10 mg
J9178	Epirubicin HCI 2 mg	J9600	Porfimir sodium 75 mg

Posted: 11/17/2006