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Pay attention to hierarchy of CPT codes when reporting IV infusions with IV push

APCs Insider, January 26, 2007

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Pay attention to hierarchy of CPT codes when reporting IV infusions with IV push

QUESTION: I have a question regarding how to appropriately code hydration and an IV push of a drug. Here's an example: A patient with dehydration presents to the hospital outpatient setting. Nursing starts an IV infusion of fluids. After 40 minutes, the nurse administers an IV push of Phenergan for nausea.

How should we code this scenario? If you report CPT codes 90760 and 90775, the coder receives an error for 90775, which states that this is an add-on code and can only be reported with 90765 or 90774.

ANSWER: Based on the note in the CPT Manual under 90761, in this scenario, you would report 90774 as the initial service, and 90761 as add-on. Here's why:

CPT established a hierarchy or theory for when you report IV infusions with an IV push during the same encounter. The November 2005 CPT Assistant, Volume 15, refers to this as a primary and secondary hierarchy.

Report the IV push injection as the initial code when an IV push injection was the only service provided to the patient, or when nursing only provided a hydration infusion service and IV push medication. This concept is important for proper CPT coding principles and APC reimbursement.

Listed below is the hierarchy you can use to select the primary or initial service:

Primary Service (listed by rank)

• Chemo infusions
• Chemo injections
• Non-chemo, therapeutic infusions
• Non-chemo, therapeutic injections
• Hydration infusions

Once you select the primary or initial service, report any other services as secondary (additional, sequential, or concurrent). Note that intramuscular and subcutaneous injections are not subject to the concept of initial/secondary service.

The AMA has confirmed that since you can only report one "initial" service, the hydration service is considered a secondary service. Therefore, when a provider infuses normal saline (for example, 500 CCs over a one-hour interval), report add-on code 90761 once (greater than 30 minutes) in conjunction with the stand-alone code 90774.

Instructional parenthetical notes also indicate that you may report 90761 as a secondary or subsequent service to initial service codes 90765 and 90774 (initial therapeutic, prophylactic, or diagnostic infusion or intravenous injections), as well as 96409 and 96413 (initial IV chemotherapy infusions or intravenous injections) when these are administered through the same IV access site. The AMA has confirmed that, in order to report 90761 as a secondary or subsequent service, nursing or other clinical staff must provide more than 30 minutes of hydration and document it in the record.

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