Health Information Management

Tip: Review the hierarchy for injections and infusions

APCs Insider, June 15, 2012

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CPT® guidelines include a hierarchy for coding injections and infusions. If coders aren't familiar with it or don't follow it, they can inadvertently end up either overcoding or undercoding the services.

Chemotherapy services are primary and should be ­selected as initial when provided in conjunction with therapeutic, prophylactic, or diagnostic services. Remember, the hierarchy applies to all IV injection and infusion services, so in most cases, all of these would be selected as the initial service before hydration if hydration is provided during the same encounter as another IV injection or infusion service with the exception of two separate IV sites.
Coders also need to remember that the order of the service delivery does not determine what's initial. Even if a patient receives hydration first, followed by a therapeutic infusion, and then finally chemotherapy, the chemotherapy would be reported as the initial service according to the hierarchy.
The hierarchy does not apply to physician reporting, nor does it apply to subcutaneous or intramuscular injections.
The tip is adapted from “Injections and infusions continue to confuse coders” in the June Briefings on APCs.

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