Revenue Cycle

Tip: Reporting special circumstances with injections and infusions

APCs Insider, January 3, 2014

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Even a facility with perfect orders and documentation can run into situations that are not addressed by available CPT® codes for injection and infusion services. For example, an ED may receive a patient who has already had an infusion initiated.
Hospitals can report the initial hour of the infusion even though they technically did not initiate it, because at that point new orders are written and the hospital is taking over that initiation of the infusion, according to CMS Transmittal 1139.
Coders may also be confused when a drug administration crosses over midnight. Coders must report all codes that are applicable to the encounter, then look at the respective codes and services and the actual date they were provided.
You may see multiple lines of the same CPT code with different dates of service, but you do not report multiple initial service codes by date of service. Because it's one encounter, you would only report  one initial service. The only exception would be that if an infusion was discontinuation entirely and then re-initiated at a subsequent point in time.
CMS Transmittal 1702 contains more information on how to report such services properly.
This tip is adapted from “Clearing the confusion with injections and infusions” in the December issue of Briefings on APCs.



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