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Injections/infusions quiz: Are you correctly coding multiple routes of administration?

HCPro Coder Connection, July 27, 2005

Injections/infusions quiz: Are you correctly coding multiple routes of administration?

 

Are you correctly billing multiple routes of administration under the new OPPS drug administration (injections/infusions) guidelines issued earlier this year by CMS? Read the below scenario and physician's order and see if your coding and billing matches up with that provided by Jugna Shah, MPH, president of Nimitt Consulting in St. Paul, MN, and Jennifer McPeek, RN, BSN, OCN, resource planning analyst at the Ohio State University Medical Center in Columbus.

 

Drug administration scenario: Mr. Smith receives two antiemetic drugs IV push, as well as one antiemetic drug IV infusion prior to his chemotherapy treatment. He then receives an antineoplastic drug IV push and a second antineoplastic drug IV infusion over three hours. To protect his bladder, he also receives IV fluid after his chemotherapy treatment.

 

The physician's order states:

Antiemetic #1 10 mg and antiemetic #2 25 mg IV push prior to treatment. Antiemetic IV infusion over 30 minutes prior to chemotherapy. Antineoplastic drug #1 5 mg IV push over 10 minutes followed by antineoplastic drug #2 500 mg IV infusion over three hours. Follow treatment with 500 ml IV fluid at 250 ml/hr to prevent hemorrhagic cystitis.

 

The coding

Providers should charge the following codes to represent the above scenario:

90784, IV injection with a unit of 2

90780, first hour non-chemotherapy infusion with a unit of 1

96408, chemotherapy administration, intravenous push technique, with a unit of 1

96410, chemotherapy infusion one hour, with a unit of 1

96412, chemotherapy infusion additional hours, with a unit of 2

90781, non-chemotherapy infusion additional hours, with a unit of 2

 

In this scenario, the patient receives both chemotherapy and non-chemotherapy drugs and staff use several routes of administration. First, providers place a main IV infusion line to administer the antineoplastic drugs and the non-chemo drugs. This IV start is not separately billable. The patient also will receive two antinausea drugs by IVP, and they should be charged with 90784 with units of two.

 

Following these drugs the patient will receive an additional antiemetic drug by IV infusion over 30 minutes. Therefore, there is now one unit of 90780 for this first infusion, and the hours will be added to the non-chemo infusion hours for post-hydration.

 

The nurse administers the first antineoplastic drug as ordered by IVP over 10 minutes. Charge this as 96408 with a unit of one. The second antineoplastic drug is infused over three hours and charges should reflect 96410 with a unit of one and 96412 with units of two.

 

Following completion of the antineoplastic infusion, the nurse would remove the bag of carrier solution that is remaining and attach the post-hydration bag of solution to the main IV line to infuse over two hours. This treatment would be charged as two units of 90781.

 

There are a number of issues in this scenario:

1. The patient receives chemotherapy by two different routes (i.e., injection and infusion)

2. The patient receives antiemetics by both injection and infusion

3. The patient receives post-chemotherapy hydration

 

When charging for services in 2004 and again in 2005, the only difference is that providers have more codes to use in 2005. They can and should report the multiple antineoplastic injections using CPT code 96408, as well as the total infusion duration bot for the chemotherapy infusion (96410 and 96412) and for the non-chemotherapy pre- and post-hydration hours (90780 and 90781). The APC payments generated in 2005 are similar to those generated in 2004, but the codes, units, and charge data CMS will receive from providers will be significantly different.

 

(Editor's note: This article was excerpted from HCPro, Inc.'s new book, OPPS Drug Administration Strategies: Your Comprehensive Guide to Accurate Coding, Billing, and Charging, written by Jugna Shah, MPH, and Jennifer J. McPeek, RN, BSN, OCN. For more information or to order, click here http://www.hcmarketplace.com/Prod.cfm?id=3331 or call 877/727-1728.)

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