Health Information Management

Q/A: Appropriate reporting of IVP followed by infusion of the same drug

APCs Insider, April 27, 2012

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Q: We give a loading dose of a drug via IV push before we start an infusion. May we report this with CPT® code 96375 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug) (List separately in addition to code for primary procedure.) because it is the first IV push of this drug?

A: CMS has instructed providers to follow CPT guidelines for drug administration services when reporting under the OPPS. New introductory guidelines for CY 2012 specifically address this scenario.

The guidelines state:

All sequential services require that there be a new substance or drug, except that facilities may report a sequential intravenous push of the same drug using 96376.

Therefore, considering the scenario you describe and the drug administration hierarchy, you should report the infusion as the primary service. Reporting the push with CPT code 96376 is appropriate because the IV push is an administration of the same drug.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

 



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