Q/A: Injections in the recovery room
APCs Weekly Monitor, July 9, 2010
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Q: A GE Lab hospital has its own separately identifiable recovery room setting. Is it appropriate to report CPT 96374 (therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug) for IV push injections provided to the patient in the recovery room or GE Lab procedure room for nausea, pain, or DVT?
A: The National Correct Coding Initiative (NCCI) Manual and 2007 OPPS final rule published in the Federal Register recommend that hospitals don’t separately report drug administration services in conjunction with endoscopy procedures.
CMS said in the 2007 OPPS final rule:
Therefore, we are not accepting the recommendation of the APC Panel to pay separately for all IV pushes and injections for pain management and other clinical conditions. Consistent with our current payment policy, in some cases their payment is packaged into payment for the associated procedures.
The NCCI Manual states:
Under the OPPS drug administration services related to operative procedures are included in the associated procedural HCPCS/CPT codes. Examples of such drug administration services include, but are not limited to, anesthesia (local or other), hydration, and medications such as anxiolytics or antibiotics. Providers should not report CPT codes 96360-96376 for these services.
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