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The CPT® Code 96425 refers to the administration of chemotherapy through an intra-arterial infusion technique, specifically for prolonged infusions that last more than eight hours. This method is particularly utilized in the treatment of malignant neoplasms, where a chemotherapy substance or drug is delivered directly into the artery supplying blood to the affected organ or site. This targeted approach, often termed regional or isolation chemotherapy perfusion, allows for a higher concentration of the chemotherapy agent to reach the tumor while minimizing systemic exposure and potential side effects. The procedure necessitates the use of a portable or implantable pump to facilitate the extended duration of the infusion. Prior to the infusion, a separate arterial catheterization is performed under radiologic supervision to ensure accurate delivery of the chemotherapy directly to the neoplasm. This code is specifically designated for cases where the infusion exceeds eight hours, distinguishing it from shorter infusion codes such as 96422, which covers intra-arterial infusions lasting up to one hour, and 96423, which is an add-on code for each additional hour of infusion beyond the first hour.
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The procedure associated with CPT® Code 96425 is indicated for the treatment of malignant neoplasms, where localized chemotherapy administration is required to effectively target the tumor. This method is particularly beneficial in cases where traditional systemic chemotherapy may not provide adequate therapeutic effects or may lead to significant side effects. The intra-arterial infusion technique allows for a concentrated delivery of the chemotherapy agent directly to the site of the neoplasm, enhancing the treatment's efficacy while reducing exposure to healthy tissues.
The procedure for CPT® Code 96425 involves several critical steps to ensure the effective administration of chemotherapy via intra-arterial infusion. First, the patient is prepared for the procedure, which includes obtaining informed consent and ensuring that all necessary pre-procedural assessments are completed. Following this, a separate arterial catheterization is performed under radiologic supervision. This step is crucial as it allows for the precise placement of the catheter into the artery that supplies blood to the tumor site. Once the catheter is in place, the chemotherapy substance or drug is connected to the catheter. The infusion is then initiated using a portable or implantable pump, which is designed to deliver the chemotherapy agent continuously over an extended period, specifically for more than eight hours. Throughout the infusion, the patient is monitored for any adverse reactions or complications, and adjustments to the infusion rate may be made as necessary to ensure optimal delivery of the medication.
After the completion of the prolonged intra-arterial infusion, the patient will require careful monitoring to assess for any immediate post-procedural complications or side effects related to the chemotherapy administration. It is essential to evaluate the catheter site for signs of infection or complications associated with the catheterization. Patients may also need follow-up imaging studies to assess the effectiveness of the chemotherapy treatment on the neoplasm. Additionally, instructions regarding post-procedure care, including signs and symptoms to watch for and follow-up appointments, should be provided to the patient to ensure ongoing management and support.
| Short Descr | CHEMOTHERAPY INFUSION METHOD | Medium Descr | CHEMOTX ADMN IA NFS >8 HR PRTBLE IMPLTBL PMP | Long Descr | Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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 |
| 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 1990-01-01 | Added | First appearance in code book in 1990. |
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