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CPT® Code 96542 refers to the procedure of administering chemotherapy injections directly into the subarachnoid or intraventricular spaces of the central nervous system. This is achieved through a previously implanted subcutaneous reservoir, which allows for the delivery of one or more antineoplastic agents. The use of a subcutaneous reservoir is significant as it facilitates the administration of not only chemotherapy drugs but also monoclonal antibodies, biologic response modifiers, and other antineoplastic substances. Prior to the injection, the skin over the reservoir site is meticulously prepped to ensure a sterile environment. A specialized needle is then utilized to puncture the skin and access the reservoir. Once the needle is properly positioned, the reservoir is filled with the designated amount of the chemotherapy drug or other complex biologic agent. The delivery of the drug can be accomplished either by manually compressing the reservoir, which allows the drug to flow into the subarachnoid space or ventricles, or by employing a pump mechanism for more controlled administration. Once injected, the drug mixes with the cerebrospinal fluid, enabling it to circulate and reach the targeted site of the neoplasm effectively.
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The procedure described by CPT® Code 96542 is indicated for the administration of chemotherapy agents in specific clinical scenarios. The following conditions may warrant the use of this procedure:
The procedure for CPT® Code 96542 involves several critical steps to ensure the safe and effective administration of chemotherapy agents. Each step is outlined as follows:
After the procedure, patients may require specific post-procedure care to ensure proper recovery and to monitor for any potential complications. It is important to observe the injection site for signs of infection or adverse reactions. Patients may also be advised to rest and avoid strenuous activities for a specified period. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to make any necessary adjustments to the chemotherapy regimen. Additionally, patients should be educated on potential side effects of the chemotherapy agents used and instructed to report any concerning symptoms to their healthcare provider promptly.
| Short Descr | CHEMOTHERAPY INJECTION | Medium Descr | CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT | Long Descr | Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service 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) | O1D - Chemotherapy | MUE | 1 | CCS Clinical Classification | 224 - Cancer chemotherapy |
| XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 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. | 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.) | CR | Catastrophe/disaster related | FS | Split (or shared) evaluation and management visit | GC | This service has been performed in part by a resident under the direction of a teaching physician | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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