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Tackle sequential and multiple infusion drug coding

APCs Weekly Monitor, October 26, 2007

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QUESTION: When billing for IV infusions, do you add each of the infusion times together and bill for the total time, or do you consider each drug separate and bill according to the time that the provider infused each drug?

Consider the following two scenarios:

Scenario #1-We infused drug A for one hour and 45 minutes, and then we infused drug B for 35 minutes.

Scenario #2-We infused drug A for one hour and 45 minutes and drug B for 35 minutes concurrently.

ANSWER: In response to the first example, this is a sequential infusion, meaning one drug follows another. Documentation should include start and stop time for each administration, because it is essential to the answer.

To correctly code the first scenario, report the infusion of drug A using CPT code 90765 with a unit of one equating to 16-60 minutes (1 hour) and code 90766 with unit of one equating to more than 30 minutes (45 minutes). Also report drug B using code 90767 with a unit of one equating to 16-60 minutes (35 minutes).

In the second example, this is a concurrent infusion, meaning the provider renders multiple infusions through the same intravenous line. To report CPT code 90768, and you cannot simply mix the drugs in one bag; there must be more than one bag. If you can mix the drugs in the same bag, then report only the initial infusion code (i.e., 90765). If you infuse the drugs at the same time in two different bags, use an initial infusion code (i.e., 90765) and a concurrent (i.e., 90768) code.

Note that in 2007 OPPS CPT code 90768 is a packaged service; however, in the proposed 2008 OPPS rule, the providers asked CMS to consider a separate payment structure. You can bill a concurrent infusion (code 90768) once per patient encounter.

To correctly code the second scenario, report the infusion of drug A with code 90765 with unit of one equating to 16-60 minutes (one hour). Report code 90766 with a unit of one equating to more than 30 minutes (45 minutes). You would also report drug B using code 90768 for a concurrent infusion (35 minutes).

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