Health Information Management

Use codes C8950, C8951 for Medicare non-chemo infusion

APCs Insider, January 27, 2006

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Use codes C8950, C8951 for Medicare non-chemo infusion

QUESTION: Regarding the new drug administration codes, if a patient receives a non-chemo infusion running as the primary infusion and an antibiotic every eight hours, are the antibiotics "concurrent" or "sequential"? Should we append modifier -59 for the additional doses that we give after the first one of the day? What if the patient receives two different antibiotics? Should we report them as "concurrent" or "sequential"? Should we report the appropriate codes with modifier -59?

ANSWER: According to Medicare guidelines, code the encounter as follows:

  • C8950 (IV infusion for therapy/diagnosis; up to 1 hour) for the first hour for non-chemo infusion (primary); and
  • C8951 (IV infusion for therapy/diagnosis; each additional hour) for each additional hour as supported by documentation in the medical record.

    The question also asked about modifier -59. CMS Transmittal 785 clarifies the instructions for coding and payment for drug administration under OPPS. It describes the appropriate use of modifier -59 in section C and instructs providers to use modifier -59 only when there is a distinct, separate encounter on the same date of service, and only after the provider has already billed the appropriate HCPCS code for the previous encounter. In your example, do not append modifier -59 because it is not a distinct and separate encounter.

    Transmittal 785 also states: "In the instance where infusions of the same type (e.g., chemotherapy, nonchemotherapy, intra-arterial) are provided through two vascular access sites of the same type in one encounter, hospitals may report two units of the appropriate first hour infusion code for the initial infusion hours without modifier -59".

    Therefore, if you had two separate infusion sites, bill C8950 with a unit of two. Section B of Transmittal 785 discusses different types of infusions that you can report with separate first-hour codes. It also states that because the APC payment rates are based on a "per-visit" basis, you will not receive an additional APC for the second unit regardless of the units you report (unless appended with modifier -59).

    Regardless of whether staff administer medications concurrently or sequentially within the same encounter, the coding will be the same.

    You can read Transmittal 785 at the CMS Web site: http://www.cms.hhs.gov/transmittals/downloads/R785CP.pdf



  • Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

      Briefings on APCs
    • Briefings on APCs

      Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

    • HIM Briefings

      Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

    • Briefings on Coding Compliance Strategies

      Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

    • Briefings on HIPAA

      How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

    • APCs Insider

      This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

    Most Popular