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Report C8950 twice for separate encounter or separate IV site

APCs Insider, December 30, 2005

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Report C8950 twice for separate encounter or separate IV site

QUESTION: Can our hospital report new drug administration code C8950 (IV infusion for therapy/diagnosis; up to 1 hour) more than once per day on a single patient? Do modifier -59 rules for drug administration claims in 2005 now apply to C8950?

For example, a patient receives two infusions during two separate encounters on the same day. Our problem lies with mapping 90767 (additional sequential infusion, up to one hour). Some of us feel we should map 90767 to C8951 (IV infusion each additional hour, list separately in addition to C8950), and some of us think we should map it to C8950. Could you provide some guidance?

ANSWER: Yes, you can report C8950 more than once per day on a single patient. Medicare recently clarified this in Transmittal 785 (January 2006 Update of the Hospital OPPS Manual Instruction: Changes to Coding and Payment for Drug Administration).

There are two circumstances when you can report C8950 twice for a single patient. The first is when a provider starts a second IV site. Report C8950 without a modifier for this circumstance.

The second is when a patient has an additional encounter on the same day. This additional encounter must be distinct and separate from the first. Report C8950 with modifier -59 for this scenario.

For chemotherapy administration and nonchemotherapy drug infusion, append modifier -59 to indicate that a nurse or physician performed a distinct encounter on the same date of service. For chemotherapy administration or nonchemotherapy infusion, append modifier -59 to drug administration HCPCS codes that meet the following criteria:

1. The drug administration occurs during a distinct encounter on the same date of service as previous drug administration services; and

2. The same HCPCS code has already been billed for services provided during a separate and distinct encounter earlier on that same date.

Transmittal 785 states the following:

Subsequent infusion hours: Hospitals are to report additional hours of infusion (e.g., C8951, C8955, 96423), either a continuing infusion of the same substance or drug or a sequential infusion of a different substance or drug, beyond the first hour, in accordance with §230.2.2 and §230.2.3, and only after more than 30 minutes have passed from the end of the previously billed hour. Therefore, to bill an additional hour of infusion after the first hour, more than 90 minutes of infusion services must be provided. One unit of the appropriate code is to be reported for each additional hour of infusion.

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