Health Information Management

Q/A: Infusions in an interosseous line

APCs Insider, June 18, 2010

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Q: When the nurses access an interosseous line to infuse medication, is there an infusion code we can use? The IO line had already been placed. The 963xx codes are for IV infusions, so they don’t seem to fit for IO infusions.

A: Intraosseous infusion or "IO" is the process of injection directly into the marrow of the bone and is used especially in pediatric emergencies. The needle is injected through the bone's hard cortex and into the soft marrow interior. The antero-medial aspect of the tibia often is used as it lies just under the skin and can easily be palpated and located. Anterior aspect of the femur, the superior iliac crest, and the head of the humerus are other sites that can be used.

The AMA’s CPT Knowledge Base states:

Patients receiving intraosseous infusion are typically inpatients. Hence, the intraosseous infusion per se is performed by hospital nursing staff and not separately reported with any CPT code. The physician work of ordering of the infusion (rate/dose/duration) is already included in the appropriate level of the physician’s inpatient hospital E/M service. Code 36680 (Placement of needle for intraosseous infusion) describes a procedure in which a hollow needle is inserted through the skin and through the muscle tissue to puncture the bone marrow cavity, usually in the tibia or femur of a patient, whose vessels are otherwise inaccessible. The needle is used as a method of infusing fluids into the blood vessels in the bone marrow. Therefore 36680 is the only code that can be used; do not use the 963XX codes for the infusion portion.

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