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CPT® Code 96405 refers to the administration of chemotherapy through intralesional injection, specifically targeting up to and including seven malignant lesions located in the skin or subcutaneous tissues. This procedure involves the injection of an anti-neoplastic agent, which is a type of medication designed to eradicate or reduce the size of cancerous lesions. The process begins with the cleansing of the skin surrounding the planned injection site to minimize the risk of infection. Following this, the physician carefully injects the anti-neoplastic agent directly into and around the malignant lesions. If multiple lesions are present, the physician will repeat the injection process for each lesion until all targeted areas have been treated. It is important to note that when coding for this procedure, the number of lesions treated is the determining factor for the appropriate code; thus, CPT® Code 96405 should be used for the injection of up to seven lesions, while CPT® Code 96406 is designated for cases involving more than seven lesions. This coding approach emphasizes that the focus is on the number of lesions rather than the number of injections, as a single lesion may require multiple injection sites for effective treatment.
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The indications for the use of CPT® Code 96405 include the presence of one or more malignant lesions in the skin or subcutaneous tissues that require treatment with an anti-neoplastic agent. This procedure is typically indicated for patients diagnosed with skin cancers or other malignancies that manifest as lesions on the skin, where localized treatment is deemed appropriate to either eradicate the lesions or reduce their size.
The procedure for CPT® Code 96405 involves several key steps to ensure effective administration of the chemotherapy agent. First, the physician identifies the malignant lesions that require treatment. Once the lesions are located, the area surrounding each lesion is thoroughly cleansed to reduce the risk of infection and ensure a sterile environment for the injection. After cleansing, the physician prepares the anti-neoplastic agent for injection. The physician then carefully injects the agent directly into and around the first lesion, ensuring that the medication is delivered to the targeted area. If there are additional lesions to be treated, the physician will repeat this injection process for each lesion, following the same steps of cleansing and injection. It is crucial to note that the coding for this procedure is based on the total number of lesions treated, not the number of injections performed, as a single lesion may require multiple injection sites for optimal treatment.
After the completion of the intralesional chemotherapy administration, patients may be monitored for any immediate adverse reactions to the injection. It is essential to provide post-procedure care instructions, which may include guidance on managing any localized swelling, redness, or discomfort at the injection sites. Patients should be advised to report any unusual symptoms or side effects to their healthcare provider. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to determine if additional injections or alternative therapies are necessary. The expected recovery time can vary based on the individual patient's response to the treatment and the extent of the lesions treated.
| Short Descr | CHEMO INTRALESIONAL UP TO 7 | Medium Descr | CHEMOTHERAPY ADMINISTRATION INTRALESIONAL 7 | Long Descr | Chemotherapy administration; intralesional, up to and including 7 lesions | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 1 | CCS Clinical Classification | 224 - Cancer chemotherapy |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | CR | Catastrophe/disaster related | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | LT | Left side (used to identify procedures performed on the left side of the body) | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | E1 | Upper left, eyelid | E2 | Lower left, eyelid | E3 | Upper right, eyelid | E4 | Lower right, eyelid | FS | Split (or shared) evaluation and management visit | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |