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Report medically necessary injections, infusions separately in a PACU setting

APCs Weekly Monitor, October 7, 2005

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Report medically necessary injections, infusions separately in a PACU setting

QUESTION: I have a question related to the September 9, 2005, APCs Weekly Monitor article on developing a post anesthesia care unit (PACU) policy and procedure. Are IV or IM injections administered in a PACU setting separately reportable for coding/billing, assuming there is a medically necessary physician order to administer a pain medication or antiemetic? I have not seen any documentation that indicates they should not be billed.

ANSWER: In a word, yes. You may separately bill all medically necessary infusions or injections administered in a PACU.

In a PACU, these services are not integral to the surgery because they are specific to the patient and dependent upon each patient's unique response to surgery. Typically, nurses give pain injections after assessing each patient's pain level. One patient may receive one injection, while another may receive many.

Likewise, if a nurse begins an infusion prior to surgery merely as a means to administer analgesia, do not bill it separately. But often, after surgery, the physician may change the solution or adjust the flow rate of the infusion to address a medical issue with infusion therapy. In this instance, you may separately bill the infusion, as it is no longer integral to the surgery.

For a reference, see the Medicare Claims Processing Manual, Chapter 4, Section 230.2.4. In it, CMS states, "90780 and 90781 should not be reported when the infusion is a necessary and integral part of a separately payable OPPS procedure."

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