Health Information Management

Q&A: When billing injection/infusion procedures, document the procedures appropriately to avoid "incidental only" rejections

APCs Insider, August 15, 2008

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QUESTION: I have a question regarding the modifier -25 information that the APCs Weekly Monitor recently published. A patient presents to a hospital outpatient clinic for scheduled injections of pain medication or antibiotic therapy. The nurse takes the patient?s temperature and blood pressure. The nurse then inserts a catheter and hangs a bag with the medication that will be infused.
 
In this situation, we should not enter a facility charge because the hospital did not perform evaluation and management (E/M) work. Similarly, it would not be appropriate for the hospital to charge for a facility E/M with modifier -25 because it did not render a separately identifiable E/M service with the infusion. If the bill kicks back as ?incidental services,? what should we do?  
 
ANSWER: A rejection for "incidental only" services usually means that the claim contains only supplies, drugs, or other packaged services without a primary procedure code (i.e., a claim in which all CPT codes reported on the claim have non-payable status indicators). If you billed the injection or infusion procedure, you should not receive an OPPS rejection edit for "incidental only services" because these CPT codes have an "S" status indicator which means that they are significant procedures and group to payable APCs. The hospital used hospital resources and performed services normally associated with the injection or infusion procedure. You can support the claim with appropriate documentation of the procedures, including an order from a treating physician.



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