Avoid Confusion on Infusions! Infusion and Injection Coding Tips and Tricks

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Avoid Confusion on Infusions! Infusion and
Injection Coding Tips and Tricks
Presented By Nikki Taylor, MBA, COC, CPC, CPMA,
AAPC Fellow Lead Auditor, The Coding Institute
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Learning Objectives

• Basic overview and history of infusion therapy
• Master hydration, infusion, injection and
  pediatric vaccine coding
• Nail down billing hierarchy
• Power up your knowledge of HCPCS and
• modifiers
• Get to know documentation pitfalls and
  recommendations
• Highlight helpful resources and tools

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Progression of Infusion Therapy

• First researched and attempted in 1600s
• Significant advancement in 20th and 21st century
• ????s De?trose ?as ?st used as an infusate
• ????s Slo? drip wethod of traYsfusioY
• ????s
• Disposable admin sets developed
• Flexible IV catheter introduced
• 1960 Peripherally inserted cath lines introduced
• 1970 CDC developed IV therapy guidelines

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Progression of Infusion Therapy

• ????s
• Implantable ports
• Home blood transfusion
• Osteoport developed
• Pain controlled analgesia increased
• National Standards of Infusion Practice issued by
  NITA
• First credentialing exam for nurses offered by
  NITA
• NITA changed to Intravenous Nurses Society (INS)
• MaY? wore iwproeweYts aYd deelopweYts siYce

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Back to the Basics

• Two main routes of administration for IV
• drug administration services
• Injection
• Infusion

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Back to the Basics

• Injections
• Drugs delivered in one shot
• Quickly or over a period of time
• Immediate effect
• Subcutaneously-under the skin
• Intramuscularly-deep into the muscle
• Intra-arterially directly into an artery or
  arteries
• Intravenously-directly into a vein
• Piggyback-existing IV tube inserted into a vein
• IV Push

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Back to the Basics

• Infusions
• Administration of IV fluids or drugs
• Saline or other solutions
• Over a period of time
• Therapeutic or diagnostic

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Back to the Basics

• Three main categories of drugs and medication
• Chemotherapy
• Treats cancer
• Non-chemotherapy
• Therapeutic
• Prophylactic
• Diagnostic
• Hydration
• Electrolytes
• Hanging bag with fluids
• Sugar and carbohydrates for energy

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Billing Basics Hierarchy Pay Attention to CPT
guidelines and instructions Payer Policies
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What Does CPT Say?

• Hierarchy
• Applies to facility not clinic setting
• ?Chewotherap? serices are priwar? to
  therapeutic, prophylactic, and diagnostic
  services which are primary to hydration
  services. Infusions are priwar? to pushes ?hich
  are priwar? to iYjectioYs.?

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What Does CPT Say?

• Hierarchy
• IV pushes are subject to the hierarchy
• Subcutaneous and intramuscular injections are not
• Do Yot coYtaiY ?iYitial? iY their descriptors
• Are not IV services
• Overrides parenthetical instructions for add-on
  codes
• Use parenthetical notes in conjunction with the
  hierarchy
• Hierarchy takes precedence

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Chemotherapy IV Infusion
Hierarchy
Chemotherapy IV Push
Chemotherapy Injection (IM/SQ) Non-Chemotherapy
IV Infusions Non-Chemotherapy IV Push
Non-Chemotherapy Injections Hydration IV Infusion
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Drug Administration Services

• Three categories
• Hydration
• 96360-96361
• Therapeutic, prophylactic, diagnostic (Injections
  and Infusions)
• 96365-96379
• Chemotherapy, High complex drug or biologic agent
• 96401-96549

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Drug Administration Services

• Initial, sequential, and concurrent services
• Add-on Codes
• Pay attention to the descriptors
• Remember IV injection and infusion admin codes
  are subject to
• hierarchy in the facility setting and NOT in
  office setting

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Initial Services

• Professional Services
• Primary reason for the encounter
• Regardless of the sequential order in which the
  injections or infusions are administered
• Facility
• Based on hierarchy
• Use only 1 initial service code
• Unless the protocol or patient condition requires
  two separate IV
• lines to be utilized
• The difference in time and effort would be
  reported using the initial
• service code with modifier -59 added

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Sequential Services

• IV push or infusion of a new substance or drug
  following the primary or initial service
• All sequential services require a new substance
  or drug
• Facilities may report a sequential intravenous
  push of the same drug using 96376 Therapeutic,
  prophylactic, or diagnostic injection (specify
  substance or drug) each additional sequential
  intravenous push of the same substance/drug
  provided in a facility (List separately in
  addition to code for primary procedure)

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Concurrent Services

• Infusion of a new drug or substance infused at
  the same time as another substance or drug
• Not time based
• Can only be reported once per day
• Regardless of whether an additional new drug or
  substance is administered concurrently
• Hydration may not be reported with any other
  service
• A separate subsequent concurrent administration
  of another new drug or substance (3rd substance)
  is not reported
• Multiple infusions of the same drug or substance
  on the same DOS, the initial code should be
  reported
• The 2nd or subsequent infusion(s) should be
  reported based on the individual time of each
  additional infusion of the same drug or substance
  using the appropriate add on code.

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Important Questions to Ask
Method?

• Chemotherapy
• Non-Chemotherapy
• Injection
• Infusion
• IV Push

• lt 15 minutes
• gt 15 minutes
• First hour
• Each additionalhour

• IV Infusion
• IV Injection
• SubQ
• Intramuscular
• Combination

What did the patient receive?
Time?
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