Health Information Management

Q/A: Drug administration services that cross midnight

APCs Insider, March 2, 2012

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Q: The AMA issued new CPT® drug administration services guidelines for reporting an initial service that is interrupted and crosses dates. For example, if a nurse administers an IV push at 10 p.m. February 10 and another IV push at 1 a.m. February 11, CPT guidelines instruct coders to report a second initial service. This differs from what we have been doing. Can you advise us?

A: For CY 2012, the AMA updated the guidelines in the introductory notes for drug administration services. The new instructions do include information about reporting a second initial service if an IV push is administered on two dates of service during one encounter.

However, CMS has not changed its stance regarding reporting one initial service per encounter, even if the encounter crosses multiple dates of service. The drug administration services should be line-item reported for the date they are provided, but “only one initial drug administration service, including infusion services, per encounter for each distinct vascular access site, with other services being reported via the sequential, concurrent or additional hour codes,” according to Transmittal 2141.

CMS notes in Transmittal 2386 that it has “subsequently become aware of new CPT guidance regarding the reporting of initial drug administration services in the event of a disruption in service; however, Medicare contractors are to continue to follow the guidance” in the Medicare Claims Processing Manual, Chapter 4, §230.2.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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