Correct Coding for Infusions and Injections - NAMAS

1 1 Correct Coding for Infusions and Injections1jRegan Tyler, CPC, CPC-H, CPMA, CEMC, ACS-EM Agenda The hierarchy facility vs. clinic for infusion Coding - Initial, each additional, each sequential, concurrent Documentation of start and stop times Chemo and non-chemo infusion pumps2 Evaluation and Management (E/M) visits performed the same day as infusion services Coding hydration infusion with other infusion services Blood draws, phlebotomy, and port flushesSupervision Levels General Supervision - means the procedure is furnished under the physician s overall direction and control, but the physician s presence is not required during the performance of the procedure. Direct Supervision - means the physician must be present and immediately available to furnishassistance and direction throughoutimmediately available to furnish assistance and direction throughout the performance of the procedure.

2 It does not mean that the physician must be present in the room when the procedure is performed. Personal Supervision - means a physician must be in attendance in the room during the performance of the procedure. 32 Infusion/Injection Services performed in the facility settingFor all Infusions reported by the facility, IV pushes and Injections are coded based on a hierarchy. The hierarchy determines which infusion service will be coded as the initial. Chemotherapy services are primary to therapeutic, prophylactic and diagnostic services which are primary to Chemotherapy41. Chemotherapy2. Therapeutic, prophylactic and diagnostic services3. HydrationInfusions are primary to IV pushes, which are primary to Infusion2. IV Push3. InjectionInfusion/ Injections performed in the clinic settingThe initial code should be the code that best describes the key or primary reason for the encounter The order in which5the encounter.

3 The order in which Infusions and Injections occurs, does not effect which code is the vs. Non-Chemotherapy vs. HydrationChemotherapyChemotherapy administration codes are for the administration of:6 Non-radionuclide anti-neoplastic drugs Anti-neoplastic agents for treatment of non-cancer diagnosis Certain monoclonal antibodies These services require directphysician vs. Non-Chemotherapy vs. HydrationTherapeutic, Prophylactic and Diagnostic Injections and IV Infusions (Non-Chemotherapy)This category of codes is for the administration of: 7 Therapeutic, Prophylactic, Diagnostic substances/drugs These services typically require directphysician vs. Non-Chemotherapy vs. HydrationHydrationHydration IV Infusions consist of pre-packaged fluid and electrolytes (examples: normal saline, 8y( pD5-1/2 normal saline). These services usually require directphysician vs. IV Push vs. InjectionInfusionAn infusion is defined as any substance infused through any type of line for greater than 15 minutes and up to one9greater than 15 minutes and up to one vs.)

4 IV Push vs. InjectionIV PushAn infusion of 15 minutes or lessORAij ti i hih hdiit10An injection in which whomever administers the substance/drug is continuously present Infusion vs. IV Push vs. InjectionInjectionAny intramuscular, subcutaneous or intra-arterial injection 11 Administration Code CategoriesEach code in the infusion section of the code book is defined using one of the following terms:12 Initial Each additional hour Each additional sequential Concurrent Infusions5 Initial Infusion/IV Push The initial code may be chosen based on the hierarchy or based on the primary reason for the encounter-it depends on where the service was performed. The order in which drugs/substances are infused or injected does not reflect the code choice. 13 Only one initial code is reported per encounter (no matter how many drugs are administered) unless protocol requires that two separate IV sites be used.

5 There is one initial code in each category of codes (Chemo infusion, chemo IV push, Non-chemo infusion, Non-chemo infusion, hydration )Each Additional Hour ( Infusions only) These codes are used for any additional time beyond the first hour of an infusion. Time must be documented as greater than 30 minutes beyond the first hour of initial1430 minutes beyond the first hour of initial and/or sequential Infusions . This code can be reported with any number of units depending on length of the infusionEach Additional Sequential ( Infusions or IV Push) For each additional drugthat is infused sequentially to the initial infusion, use the each additional sequential infusion This code can only be billed once per drugfor the first hour of each sequential infusion. For any additional time past the first hour (greater than 30 minutes) use the each additional hour Infusions Use this code when two substances/drugs in two separate bags/syringesare infused at the same time through one access16access.

6 This code can only be billed once per patient encounter. Only used for non-chemotherapy ServicesCHEMOTHERAPEUTICHYDRATIONINITIAL 964139636596360 Each Additional Hour+96415+96366+96361 Subsequent+96417+96367 Concurrent+96368 Push Initial9640996374 Subsequent Push New+96411+96375 Subsequent Push Same+96376 (Facility only 30 min apart)CPT CodesChemotherapyIntravenous Infusion 96413-Chemotherapy administration intravenous infusion technique; up to 1 hour, single or initialsubstance or drug18substance or drug 96415-Chemotherapy administration intravenous infusion technique; each additional hour 96417-Chemotherapy administration intravenous infusion technique; each additional sequential infusion(different substance/drug), up to 1 hour7 CPT Codes continuedChemotherapy Infusion 96422-Chemotherapy administration, intra-arterial; infusion technique,up to one hour19infusion technique, up to one hour 96423-Chemotherapy administration, intra-arterial; infusion technique, each additional hour 96420-Chemotherapy administration, intra-arterial; pushtechniqueCPT Codes continuedChemotherapy Push 96409-Chemotherapy administration intravenous2096409 Chemotherapy administration intravenous, push technique, single or initialsubstance/drug 96411-Chemotherapy administration intravenous, push technique, each additionalsubstance/drugCPT Codes continuedChemotherapy 96401-Chemotherapy administration, subcutaneous or intramuscular,non-hormonal anti-neoplastic21intramuscular, nonhormonal antineoplastic 96402-Chemotherapy administration, subcutaneous or intramuscular, hormonal anti-neoplastic 96405-Chemotherapy administration; intralesional, up to and including 7 lesions 96406-Chemotherapy administration.

7 Intralesional, more than 7 lesions8 CPT Codes continuedChemotherapy 96440-Chemotherapy administration into pleural cavity, requiring and including thoracentesis96446 Chthd i i t tii titl22 96446-Chemotherapy administration into peritoneal cavity via indwelling port or catheter 96450-Chemotherapy administration into CNS (intrathecal), requiring and including spinal puncture 96542-Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents 96549-Unlisted chemotherapy procedureCPT Codes continuedTherapeutic, Prophylactic and Diagnostic Injections and IV Infusions (non-chemo)Intravenous Infusions 96365-Intravenous infusion, for therapy, prophylaxis, or diagnosis;initialup to one hour23diagnosis; initial, up to one hour 96366-Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour 96367-Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional sequentialinfusion, up to 1 hour 96368-Intravenous infusion, for therapy, prophylaxis, or diagnosis; concurrent infusionCPT Codes continuedTherapeutic, Prophylactic and Diagnostic Injections and IV Infusions (non-chemo)Subcutaneous Infusions 96369-Subcutaneous infusion for therapy or prophylaxis; initial, up to one hour, including pump set-up and 24,p,gp ppestablishment of subcutaneous infusion sites 96370-Subcutaneous infusion for therapy or prophylaxis; each additional hour 96371-Subcutaneous infusion for therapy or prophylaxis; additional pump set-up with establishment of new subcutaneous infusion sites9 CPT Codes continuedTherapeutic, Prophylactic and Diagnostic Injections and IV Infusions (non-chemo)IV Push 96374-Therapeutic, prophylactic or diagnostic injection.

8 Intravenous push single orinitialsubstance/drug25intravenous push, single or initialsubstance/drug 96375-Therapeutic, prophylactic or diagnostic injection; each additional sequentialintravenous push of a newsubstance/drug 96376-Therapeutic, prophylactic or diagnostic injection; each additional sequentialintravenous push of the samesubstance/drug (facility only) (IV pushes must be greater than 30 minutes apart)CPT Codes continuedTherapeutic, Prophylactic and Diagnostic Injections and IV Infusions (non-chemo) Injections 96372-Therapeutic, prophylactic or diagnostic injection;2696372 Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular (SQ/IM) 96373-Therapeutic, prophylactic or diagnostic injection; intra-arterialCPT Codes continuedTherapeutic, Prophylactic and Diagnostic Injections and IV Infusions (non-chemo)Other27 96379-Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion10 CPT Codes continuedHydrationIntravenous Infusion 96360-Intravenous infusion, hydration ; initial, 31 it t1h28minutes to 1 hour 96361- Intravenous infusion, hydration ; each additional hourExample # 1 Patient presents for weekly chemo outpatient treatment in the hospital.

9 He receives: 29 2 hour infusion of 1stchemo drug 1 hour infusion of 2ndchemo drug 10 minute non-chemo IV push IM injectionExample # 11. Determine which service will be the initial using the Determine where the other services will fall; each additional , each sequential , or concurrent .30 Answer:1. 2 hour infusion of 1stchemo drug = 96413 (initial) and 96415 (each additional hour)2. 1 hour infusion 2ndchemo drug = 96417 (each sequential)3. 10 minute non-chemo IV push = 96375 (each additional)4. IM injection = 96372 (injection) modifier 59 Reminder to check CCI for bundled codes that may need a modifier11 Example # 2 Patient presents for weekly chemo in a clinic based infusion center, she receives:50 i t i f i1thd31 50 minute infusion 1stchemo drug 2 hour, 45 minute infusion 2ndchemo drug 3 separate non-chemo IV pushes of different substancesExample # 2 Chose the initial code based on the reason for the :32 50 minute infusion 1stchemo drug = 96413(initial) 2 hours, 45 minutes infusion 2ndchemo drug = 96417(each sequential) and 96415 x 2(each additional) 3 separate non-chemo IV pushes of different substances = 96375 x 3(each additional sequential)Example # 3 Dehydrated patient sent to the infusion suite in their physician s office, he receives.

10 NhIVhf titi33 Non-chemo IV push of an anti-emetic 2 hours of hydration infusion12 Example # 3 Chose the initial code based on the reason for the :34 Non-chemo IV push = 96375(each additional) 2 hours hydration infusion = 96360 x1(initial) and 96361 x 1(each additional)Services Bundled into Infusion/Injection Services Any services leading up to the infusion or following the infusion are included in the infusion administration and are not separately reportable. Use of local anesthesia35 IV start Access to indwelling IV, subcutaneous catheter or port Flush at conclusion of infusion Standard tubing, syringes and supplies Preparation of chemotherapy agentsStart and Stop Times3613 Start and Stop Times When reporting codes for which infusion time is a factor, use the actual timeover which the infusion is i f itiil l t d fth tith37 The infusion time is calculated from the time the administration begins (the medication starts dripping) to when it ends (the medication stops dripping).