tci Part B Insider - 2009 Issue 45

READER QUESTIONS: Heed the 'Re-' Term in 96521's Descriptor -- It Refers to 'Refill'

Know the CCI edits when attempting to report chemotherapy administration along with portable pump refills. Question: Are we able to bill 96521 and 96416 on the same date? We had one payer who reimbursed both, but Medicare has been denying our claims. Do we need to use a modifier? Answer: You should not report 96416 (Chemotherapy  administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion [more than 8 hours], requiring use of a portable or implantable pump) on the same date as 96521 (Refilling and maintenance of portable pump). Why: Any payers that adopt Medicare's Correct Coding Initiative (CCI)...

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