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Code injections and infusions accurately

HIM-HIPAA Insider, June 22, 2005

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A working knowledge of injections and infusions will help staff determine what codes to charge for services paid under the 2005 outpatient prospective payment system (OPPS) rule.

CPT Assistant defines infusion as "the administration of intravenous fluids/drugs over a period of time for diagnostic or therapeutic purposes." It describes injections as delivering a dosage in "one shot" rather than over a period of time. These definitions can still be somewhat confusing, however. Here is an easy way to distinguish between the two from a clinical perspective:

An infusion requires a "bag or bottle"--large or small--and a tube (including IVPBs) to carry solution from the bag or bottle into the vein or artery. An injection always includes a syringe and either a needle or a needleless catheter to get the liquid from the syringe into the body.

When billing the many different routes of administration of drugs, distinguish clearly between injection and infusions to ensure that your facility assigns the correct CPT codes. Injecting a chemotherapy drug in the abdomen or infusing the same drug into a normal IV line in the arm would be billed under two different CPT codes.

The latest CMS guidance
Transmittal 573 defines intravenous or intra-arterial push injections as follows:

Intravenous or intra-arterial push: Hospitals are to bill push codes (e.g., 96408, 96420, 90783, and 90784) for services that meet existing CPT guidelines and meet either of the following criteria:

• A healthcare professional administering an injection is continuously present to administer and observe the patient
• An infusion is administered lasting 15 minutes or less

This revised information may seem counterintuitive to healthcare professionals, especially nurses, because an injection is different from an infusion, regardless of the duration of the infusion. However, for reporting purposes, the above guidance states that providers must report infusions that last 15 minutes or less with an appropriate push code injection. The significance of this information is that providers will now report short-duration infusions, such as a 15-minute antiemetic infusion prior to the administration of chemotherapy, using CPT code 90784 rather than reporting the first-hour infusion service code 90780. Given this change, hospitals must provide education to nursing and infusion room staff, as well as to others involved in the charging process, and must update existing encounter forms or charge tickets.

Editor's note: Stay tuned for next week's HIM Connection. We'll bring you the new drug administration codes and rules for reporting them.

This excerpt is adapted from the book OPPS Drug Administration Strategies: Your Comprehensive Guide to Accurate Coding, Billing, and Charging.

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