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CPT® Code 96423 refers to the administration of chemotherapy via an intra-arterial infusion technique, specifically for each additional hour of treatment beyond the initial hour. This method is utilized primarily for the treatment of malignant neoplasms, where a chemotherapy substance or drug is delivered directly into the artery that supplies blood to the affected organ or site. The intra-arterial infusion technique, also known as regional or isolation chemotherapy perfusion, allows for a concentrated delivery of the chemotherapy agent directly to the tumor, potentially increasing its effectiveness while minimizing systemic exposure. The procedure typically involves the use of arterial catheterization, which is performed under radiologic supervision to ensure accurate placement of the catheter for optimal drug delivery. It is important to note that this code is used as an add-on to the primary procedure code for the initial hour of infusion, which is reported using CPT® Code 96422. For cases requiring prolonged chemotherapy administration beyond eight hours, CPT® Code 96425 should be utilized, which accounts for the use of a portable or implantable pump for the infusion process.
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The use of CPT® Code 96423 is indicated for patients undergoing chemotherapy treatment specifically for malignant neoplasms. The intra-arterial infusion technique is particularly beneficial in cases where localized treatment is necessary to target the tumor directly, thereby enhancing the efficacy of the chemotherapy while reducing the potential side effects associated with systemic administration. This method is often employed when the tumor is situated in an area that can be accessed via the arterial supply, allowing for a more concentrated delivery of the chemotherapeutic agent.
The procedure for administering chemotherapy via intra-arterial infusion involves several critical steps to ensure effective treatment delivery. First, the patient is prepared for the procedure, which may include obtaining informed consent and performing necessary pre-procedural assessments. Following this, arterial catheterization is performed under radiologic supervision to accurately place the catheter in the artery supplying blood to the tumor. This step is crucial as it allows for the direct infusion of the chemotherapy agent to the targeted site. Once the catheter is in place, the chemotherapy substance or drug is infused into the artery using a controlled infusion technique. The initial infusion is reported using CPT® Code 96422 for the first hour. For each additional hour of infusion, CPT® Code 96423 is utilized as an add-on code, ensuring that the total duration of chemotherapy administration is accurately captured for billing purposes. It is essential to monitor the patient throughout the procedure for any adverse reactions and to ensure the effectiveness of the drug delivery.
After the completion of the intra-arterial chemotherapy infusion, the patient is typically monitored for a period to assess for any immediate side effects or complications resulting from the procedure. This may include monitoring vital signs and observing the infusion site for any signs of infection or adverse reactions. Depending on the patient's condition and the specific chemotherapy regimen, follow-up care may be required, which could involve additional imaging studies or laboratory tests to evaluate the effectiveness of the treatment. Patients may also receive instructions regarding post-procedure care, including signs and symptoms to watch for that may indicate complications. It is essential for healthcare providers to ensure that patients understand their follow-up appointments and any additional treatments that may be necessary as part of their overall cancer care plan.
| Short Descr | CHEMO IA INFUSE EACH ADDL HR | Medium Descr | CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR | Long Descr | Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No 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) | 0 - 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 | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 1 | CCS Clinical Classification | 224 - Cancer chemotherapy |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96422 | MPFS Status: Active Code APC S Physician Quality Reporting PUB 100 CPT Assistant Article Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour |
| 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. |
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| 2007-01-01 | Changed | Code description changed. |
| 2006-01-01 | Changed | Code description changed. |
| 1990-01-01 | Added | First appearance in code book in 1990. |
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