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Report sequential infusions with 90767

APCs Weekly Monitor, April 7, 2006

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Report sequential infusions with 90767

QUESTION: Now that we have started using the 2006 drug administration codes, a question arose: We understand when to report 90765 and 90766, but when is it appropriate to report 90767? The definition of "sequential infusion" is not clear. Also, do you report 90767 for a first hour and then 90766 if the infusion lasts more than one hour?

ANSWER: Introduced in 2006, CPT 90767 is defined as: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure). This and other new CPT codes were established to report sequential and concurrent infusions and to identify the time and effort in providing access for these services.

A concurrent injection/infusion is a service in which multiple infusions are provided through the same intravenous line. A sequential infusion is considered to be an infusion of a different drug administered immediately following the initial infusion, in other words one drug after the other.

It is of critical importance for clinical staff to keep accurate documentation. They must include the start and stop time of each drug(s) infused when reporting CPT 90767. Remember, CPT 90767 is an add-on code and you must report it with 90765, 90774, 96409, and 96413, if provided as a secondary or subsequent service after a different initial service. Report 90767 only once per sequential infusion of same infusate mix.

For example, a patient receives an infusion of drug #1 (IVPB) from 10:15-11:15, and drug #2 from 11:20-1:20 (IVPB). The correct code assignment according to the CPT 2006 manual is:

• 90765 (Drug #1): Time and documentation requirement for 1st hour is 16 - 60 minutes
• 90767 (Drug #2): Sequential drug, based upon the above time listed, 16 - 60 minutes for the 1st hour
• 90766 (Drug #2): Sequential drug, infusion lasted total of 2 hours, therefore, report the remaining time with 90766; subsequent hour requires documented 31 minutes or more of infusion time.

Remember, CMS requires C codes and the above definition does not apply to C8950 and C8951. For Medicare reporting, the correct code assignment for the above example is:

• C8950: Intravenous infusion for therapy/diagnosis; up to 1 hour;
• C8951: Intravenous infusion for therapy/diagnosis; each additional hour (List separately in addition to C8950); reported with 2 units.

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