Health Information Management

How to bill IV infusion time to Medicare and non-Medicare payers

APCs Insider, February 10, 2006

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How to bill IV infusion time to Medicare and non-Medicare payers

QUESTION: We have a coding question regarding infusion of medications. The patient was in the observation unit as an outpatient. He received IV fluids, but the documentation does not specify whether they were for hydration. Nursing staff administered three IV infusion doses of Kefzol over eight hours. Each dose of IV Kefzol infusion took approximately thirty minutes to infuse. What codes should we use to report the IV infusion and medication?

ANSWER: Based on the information in your scenario, the IV fluids are not for a specific therapeutic purpose. The patient recieved them merely as a vehicle to carry the three separate IV Kefzol infusions (each lasting 30 minutes). Because each IV infusion is through the same IV site, add the duration time of each IV infusion together. This totals 90 minutes of infusion time.

Report C8950 (IV infusion for therapy/diagnosis; up to one hour) to Medicare. For non-Medicare payers, report 90765 (IV infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to one hour).

Both Medicare and non-Medicare payers require that the infusion time must be greater than 30 minutes beyond the first hour code, or 91 minutes, before you can report an each additional hour code (C8951 or 90766 for Medicare and non-Medicare, respectively).

Work with your clinical staff to develop appropriate abbreviations to include IV piggy back (IVPB) along with time up (10:15, for example) and time down (11:15, for example) of medications to help avoid "infusion confusion." Both Medicare and non-Medicare providers require you to document the total time of infusions and the associated units for each IVPB drug. Proper documentation must include the time the bag was first hung or the drug was piggybacked into the infusion along with the end time of the infusion.

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