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 • 1920’s Dextrose was 1st used as an infusate • 1930’s Slow drip method of transfusion • 1940’s • Disposable admin sets developed • Flexible IV catheter introduced
• 1960 Peripherally inserted cath lines introduced • 1970 CDC developed IV therapy guidelines 3
Progression of Infusion Therapy • 1980’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) Many more improvements and developments since…
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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 • “Chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes which are primary to injections.”
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What Does CPT Say? • Hierarchy • IV pushes are subject to the hierarchy • Subcutaneous and intramuscular injections are not • Do not contain “initial” in 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 15
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. 17
Important Questions to Ask
• Chemotherapy • Non-Chemotherapy • Injection • Infusion • IV Push
What did the patient receive?
Method? • IV Infusion • IV Injection • SubQ • Intramuscular • Combination
• < 15 minutes • > 15 minutes • First hour • Each additional hour
Time?
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