The physician has recently performed an ommaya tap with chemo on a hospitalized patient. In the office setting we would bill 96542. What would be the correct CPT code for a performing these services in the hospital?
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- Posted by Nancy Brewington 7 months ago. There are 6 posts. The latest reply is from Nancy Brewington.
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When these codes are reported by the facility, the following instructions apply: The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy is to be followed by facilities and supersedes parenthetical instructions for add-on codes that suggest an add-on of a higher hierarchical position may be reported in conjunction with a base code of a lower position. (For example, the hierarchy would not permit reporting 96376 with 96360, as 96376 is a higher order code. IV push is primary to hydration.)
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I am sorry that was a little confusing. Is there a code in which the Provider who sees the patient in the hospital for an ommaya tap with chemo can charge or is it bundled with the hospital charge? The provider is not an employee of the hospital.
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I have forwarded this question to our research team for a better answer. Need more time plz.
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As per the CPT Assistant February 2009 page 17 -->
"In the facility setting, with the exception of codes 96405, 96406, 96440, 96445, 96450, and 96542, the physician would not report codes 96360-96549. The appropriate Evaluation and Management (E/M) service code when performed in the facility setting (ie, inpatient hospital, emergency department, or observation care) is generally the service being performed whereby the physician directs the facility administration of the hydration, drug or biologic administration."
So you can stil report 96542 for the service in facility set up for the chemo infusion via ommaya tap.
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Thank you!!
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