General Question for the Week of September 2, 2024

Question:

Why can’t we code 95180 (rapid desensitization) and chemotherapy drug administration codes together when we perform carboplatin desensitization?

Answer:

Code 95180 and the drug administration codes (96360–96379, 96401–96549) describe similar services and these are all time-based. Time-based means that services performed at the same time cannot be counted twice. Because all these codes describe the administration of the actual drug, it would not be appropriate to report these codes together. Instead, use the applicable chemotherapy drug administration codes. This response is supported by the advice from the American Hospital Association (AHA) published guidance and AMA time-based reporting. Additionally, in 2006, CMS published guidance in Transmittal 804 to state that it considers code 95180 a per encounter (per visit) code rather than report per hour, and no further guidance has been published. So, based on OPPS, if we only report one unit of 95180, we would only be paid approximately $330. The first hour of IV chemotherapy is paid approximately $298.

This question was answered in our Coding Essentials for Infusion & Injection Therapy Services. For more hot topics relating to infusion services, please visit our store or call us at 1.800.252.1578, ext. 2.