96413

Chemotherapy administration, intravenous infusion, up to 1 hour, initial substance

This procedure code describes the intravenous administration of antineoplastic agents (chemotherapy) for therapeutic purposes, specifically covering the preparation and infusion of the first or single chemotherapy drug for up to one hour.

Clinical Indications

  • Treatment of various types of solid tumors (e.g., breast cancer, lung cancer, colorectal cancer, ovarian cancer)
  • Treatment of hematologic malignancies (e.g., leukemia, lymphoma, multiple myeloma)
  • Adjuvant or neoadjuvant therapy to reduce tumor size or prevent recurrence
  • Palliative chemotherapy to manage symptoms and improve quality of life in advanced cancers
  • Certain autoimmune or inflammatory conditions where antineoplastic agents are used off-label (less common for this specific code but possible depending on the drug and indication)

Procedure Steps

  1. Patient assessment including vital signs, current symptoms, and review of recent laboratory results (e.g., CBC, renal/hepatic function).
  2. Verification of chemotherapy order, patient identity, and allergy status.
  3. Preparation of the chemotherapy agent(s) according to established protocols, including sterile compounding and dilution.
  4. Establishment of appropriate intravenous access (e.g., peripheral IV, central venous catheter).
  5. Initiation of the chemotherapy infusion at the prescribed rate.
  6. Continuous monitoring of the patient for adverse reactions, infusion site complications, and vital sign changes during the first hour of infusion.
  7. Documentation of drug administered, start and end times, infusion rate, patient response, and any adverse events.

Coding Guidelines

  • Code 96413 is used for the intravenous infusion of the initial or single chemotherapy substance for up to one hour.
  • If the infusion lasts longer than one hour, add-on code 96415 (each additional hour) should be used for each subsequent full hour. Partial hours greater than 31 minutes also qualify for an additional hour unit.
  • Preparation of the chemotherapy drug(s) is included in the administration code and should not be billed separately.
  • This code specifically applies to antineoplastic agents. For non-chemotherapeutic therapeutic infusions, use appropriate codes from the 96365-96376 series.
  • Hydration, antiemetics, or other ancillary infusions given concurrently or sequentially with chemotherapy may be coded separately if they meet medical necessity criteria and are distinct services (e.g., 96360-96361 for hydration, 96365-96368 for therapeutic infusions).
  • Only one 'initial' code (96413) should be reported per encounter for chemotherapy administration, regardless of the number of chemotherapy drugs administered, as long as they are infused consecutively via the same IV access.
  • If multiple distinct chemotherapy agents are given and each requires a separate, initial intravenous setup (e.g., separate sites or completely separate administrative periods), review payer guidelines for reporting multiple initial codes or using add-on codes.

Associated ICD-10 Codes