Health Information Management

Q&A: Follow the infusion hierarchy, not chronological order of administration, when reporting drug administration services

APCs Insider, September 26, 2008

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

QUESTION: How should a facility bill for the following scenario in a hospital outpatient setting (e.g., an emergency department)?

 

A patient presents with abdominal pain and we administer an IV push of a pain medication. Afterward, the patient receives a therapeutic IV infusion of an antibiotic.

 

CPT guidelines state that a facility should follow a strict hierarchy of coding regarding injections and infusions, whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services, which in turn are primary to hydration services. Infusions are primary to pushes, which in turn are primary to injections.

 

Following these guidelines, I feel that we should code the antibiotic infusion as the primary service (CPT code 90765) and the IV push of morphine (CPT code 90775) as a subsequent service. Since the antibiotic infusion is higher in the hierarchy than the IV push, I think we should code it as the primary service, even though we administered the IV push first. I have seen facilities bill CPT code 90774 for the IV push and CPT code 90766 or CPT code 90767 for the therapeutic infusions. However, I don’t think this is correct. What is your opinion concerning this scenario?

 

ANSWER: The CPT introductory notes for the "Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (excludes chemotherapy)" section of the CPT Manual state the following:

 

When these codes are reported by the facility, the following instructions apply. The initial code should be selected using a hierarchy whereby 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. This hierarchy does not apply to physician reporting.

 

In addition to these instructions, the parenthetical note for CPT code 90775 states:

 

Use 90775 in conjunction with 90765, 90774, 96409, 96413.

 

The parenthetical note for CPT code 90766 states:

 

Report 90766 in conjunction with 90765, 90767. 

 

The notes do not say to use CPT code 90766 in conjunction with CPT code 90774. Therefore, you cannot use CPT code 90766 to report an infusion as a secondary service to an injection. Based on the hierarchy, and the parenthetical notes for these CPT codes, you should report the antibiotic infusion as the primary service (code 90765) and the IV push as the subsequent service (code 90775).



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Comments

0 comments on “Q&A: Follow the infusion hierarchy, not chronological order of administration, when reporting drug administration services

 

Most Popular