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 are all time-based. Time-based means that services performed at the same time cannot be counted twice. Because all of these codes describe the administration of the actual drug, it would not be appropriate to report them together. Instead, use the applicable chemotherapy drug administration codes. This response is supported by guidance from the American Hospital Association (AHA) and AMA time-based reporting. Additionally, in 2006, CMS published guidance in Transmittal 804 stating that it considers code 95180 a per-encounter (per visit) code rather than a per-hour code, and no further guidance has been published. Therefore, based on OPPS, if only one unit of 95180 is reported, reimbursement would be approximately $330, while the first hour of IV chemotherapy is reimbursed at approximately $298. The coding and billing guidance is different for professional billing.
