Health Information Management

Does your facility struggle with injection and infusion coding and billing?

APCs Insider, January 9, 2015

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By Steven Andrews
 
We consistently receive questions about coding for injections and infusions, even though the codes and guidelines have remained the same for years. Readers routinely ask about billing for multiple drugs and concurrent infusions or how to follow the hierarchy.
 
Consider the following example:
 
A 71-year-old patient received the following drugs by IV through a single site in a hospital outpatient clinic:
  • Piperacillin from 1430-1500
  • Levaquin® from 1456-1559
  • Vancomycin® from 1517-1650
The Levaquin overlaps in part with the piperacillin. The Vancomycin does not overlap with the piperacillin, but does with the Levaquin. Is the Vancomycin subsequent to the piperacillin or concurrent to the Levaquin? And which CPT® codes would be assigned?
 
"Concurrent infusions are tricky, because the question that comes up a lot is how much has to be concurrent?" says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota. Citing CPT Assistant, she said that infusions are considered concurrent if they overlap for a "majority" of the time.
 
With the piperacillin and Levaquin overlapping for only 4 minutes, the correct codes to report would be:
 
  • 96365, intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour
  • 96367, intravenous infusion, for therapy, prophylaxis, or diagnosis; additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
 
The Levaquin and Vancomycin overlap for a longer period of 42 minutes, but then the Vancomycin IV continues for another 51 minutes. Since they did not overlap for a majority of the time, the correct code to report would be a sequential infusion with 96367.
 
"It's tricky when you have two drugs overlapping in two different places," Shah says. "You want to check to see what's overlapping and how much overlaps, whether it's the majority or not. If it's not, you pick up the non-overlapping times subject to the time requirements."
 
Join Shah and Valerie A. Rinkle, MPA, associate director with Navigant Consulting in Seattle, for HCPro's popular annual injections and infusions webcast at 1 p.m. (Eastern) Thursday, January 29. They will cover key concepts for injection and infusion coding, while also taking a look at complicated billing issues regarding self-administered drugs and Medicare Part B rebilling. To learn more or to sign up, visit HCPro.com.



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