Health Information Management

Tip: Determine whether code is time-based when calculating carve-out time

APCs Insider, February 24, 2012

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If a patient receives a therapeutic service that requires active monitoring, coders must carve that time from the total observation time. A wide range of services, such as colonoscopies and administration of certain drugs, require active monitoring.

Carving out time for drug administration services can be particularly confusing because coders must consider each separate service to determine whether it requires active monitoring. Drug infusion titrations require a nurse to stand by and monitor the infusion. However, other services that fall within the same HCPCS code for drug administration do not require active monitoring.

CMS requires hospitals to follow CPT® guidelines for reporting drug administration and other services. Hospitals may only use average times for non-time-based services. Therefore, because CPT already specifies an average time of infusion (i.e., coders should report one hour of infusion when services last 31 minutes to 1 hour and 29 minutes), hospitals may not use average times when reporting this particular service.

However, CPT does not specify how much time is included in an IV push. Therefore, hospitals have some latitude when establishing an average length of time. When establishing an average, consider performing an actual time study or obtaining an approximate length of time required to push the most frequently administered drugs via this route. Nursing and/or pharmacy staff can provide information related to drug administration services. Other clinical departments can assist with information about most common diagnostic procedures

The tip is adapted from “This month’s coding Q&A” in the February issue of Briefings on APCs.



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