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Don’t forget to pay attention to 2025 HCPCS deletions and revisions.

Coding infusions is perhaps the most difficult part of an oncologist coder’s job. But the best way to improve is to practice. That’s why we’ve put together this infusion case study. Take a close look, write down your answers, then compare them with ours.

Look Over This Infusion Encounter

A patient received the following infusion:

• Cytoxan 750 mg (15:13-15:56)
• Truxima 375 mg (09:03-14:15)
• Oncovin 1.4 mg (14:46-14:56)
• Adriamycin 90 mg (14:35)
• Pepcid 20 mg (10:40-11:10)
• Emend 150 mg (08:19-08:45)
• Decadron 10 mg (09:06)
• Benadryl 25 mg (08:14)
• Aloxi 0.25 mg (08:14)

What is the correct way to code this encounter?

First, Code the Chemotherapy Administration

To code this infusion encounter, you should begin by separating out the chemotherapy drugs from the therapeutic drugs your clinic has administered to the patient, then sum up the infusion times for all the drugs administered.

Altogether, there are four chemotherapy drugs: Cytoxan, Truxima, Oncovin, and Adriamycin. In total, the patient received the Truxima for five hours and 12 minutes and the Cytoxan for 43 minutes. The Adriamycin and Oncovin administrations, as they are both under 15 minutes, would be documented as pushes.

This would lead you to code the following:

• 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) x 1 for the first hour of the Truxima infusion
• +96415 (… each additional hour (List separately in addition to code for primary procedure)) x 4 for the additional four hours and 12 minutes of the Truxima infusion
• +96417 (Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)) x 1 for the 43 minutes of the Cytoxan administration
• 96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)) x 2 for the Adriamycin and Oncovin administrations

Then, Code the Therapeutic Drug Administration

Now you can go ahead and code for the administration of the five therapeutic drugs: Pepcid, Emend, Decadron, Benadryl, and Aloxi. Again, the Aloxi, Benadryl and Decadron administrations should all be coded as pushes.

The coding looks like this:

• 96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)) x 1 for the 26 minutes of the Emend administration
• 96375 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)) x 3 for the Aloxi, Benadryl, and Decadron pushes
• 96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)) x 1 for the Pepcid, as it ran for 30 minutes concurrent to the Truxima

Note: Your organization may or may not wish to bill 96368.

Next, Calculate Drug Units

Here, the challenges are to match the correct code with the drug brand name, then calculate the amount of the drug administered with the unit of the drug listed in its HCPCS descriptor.

Cytoxan: The first drug administered is an excellent example of the first of these challenges.

Prior to Jan. 1, 2025, you had three codes to choose from: J9070 (Cyclophosphamide, 100 mg) for the Cytoxan brand, J9071 (Injection, cyclophosphamide (auromedics), 5 mg), and J9072 (Injection, cyclophosphamide, (dr. reddy's), 5 mg).

However, the Cytoxan brand has been discontinued, leading HCPCS 2025 to delete J9070; retain J9071 and J9072 (… (avyxa), 5 mg) under a new brand name; and add J9073 (… (ingenus), 5 mg), J9074 (… (sandoz), 5 mg), J9074 (…  not otherwise specified, 5 mg), and J9076 (… (baxter), 5 mg). This means you need to make sure you align code choice with the drug manufacturer.

Fortunately, the good news is that one unit for all these HCPCS codes is defined as 5 mg. So, no matter which code you bill, 750 mg of cyclophosphamide administered would equal 150 units billed.

Truxima is billed with HCPCS code Q5115 (Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg). A total of 375 mg administered would equal 37.5 units billed.

Oncovin is billed with HCPS J9370 (Vincristine sulfate, 1 mg). A total of 1.4 mg administered would equal 1.4 units billed.

Adriamycin is billed with HPCPS (Injection, doxorubicin hydrochloride, 10 mg). A total of 90 mg administered would equal 9 units billed.

Pepcid is billed with HCPCS S0028 (Injection, famotidine, 20 mg). A total of 20 mg administered would equal 1 unit billed.

Emend is billed with HCPCS J1453 (Injection, fosaprepitant, 1 mg). A total of 150 mg administered would equal 150 units billed.

Decadron is billed with HCPCS J1100 (Injection, dexamethasone sodium phosphate, 1 mg). A total of 10 mg administered equals 10 units billed.

Benadryl is billed with HCPCS J1200 (Injection, diphenhydramine HCl, up to 50 mg). A total of 25 mg administered equals 1 unit billed.

Aloxi is billed with HCPCS J2469 (Injection, palonosetron HCl, 25 mcg). This drug illustrates the other challenge in coding drug units, as the code unit is in micrograms (mcg), but the unit administered is in milligrams (mg). Knowing that 1 milligram equals 1,000 micrograms, however, will enable you to calculate that 0.25 mg administered equals 250 mcg, which equals 10 units billed.

Finally, Don’t Forget the Dx

There are a number of diagnosis codes you will need to add to your billing for this encounter:

• Z51.12 (Encounter for antineoplastic immunotherapy) will be your first-listed or primary diagnosis in this situation
• CXX.- for an appropriate diagnosis code for the cancer being treated
• R11.2 (Nausea with vomiting, unspecified) to show medical necessity for the antinausea medications
• T45.1X5A (Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter) to account for the administration of other therapeutic medications
• Z79.620 (Long term (current) use of immunosuppressive biologic) for the Truxima administration, as the drug is classified as a monoclonal antibody, an inclusion term for Z79.620
• Z79.632 (Long term (current) use of antitumor antibiotic) for the Adriamycin administration, as Adriamycin is a brand name for doxorubicin, which is an inclusion term for Z79.632.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC