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Avoid Confusion on Infusions!

Infusion and Injection Coding


Tips and Tricks
Presented By:
Nikki Taylor, MBA, COC, CPC, CPMA, AAPC Fellow
Lead Auditor, The Coding Institute

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Learning Objectives
Basic overview and history of infusion therapy
Master hydration, infusion, injection and
pediatric vaccine coding
Nail down billing hierarchy
Power up your knowledge of HCPCS and
modifiers
Get to know documentation pitfalls and
recommendations
Highlight helpful resources and tools

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Progression of Infusion Therapy
First researched and attempted in 1600s
Significant advancement in 20th and 21st century
1920s Dextrose was 1st used as an infusate
1930s Slow drip method of transfusion
1940s
Disposable admin sets developed
Flexible IV catheter introduced
1960 Peripherally inserted cath lines introduced
1970 CDC developed IV therapy guidelines

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Progression of Infusion Therapy
1980s
Implantable ports
Home blood transfusion
Osteoport developed
Pain controlled analgesia increased
National Standards of Infusion Practice issued by NITA
First credentialing exam for nurses offered by NITA
NITA changed to Intravenous Nurses Society (INS)
Many more improvements and developments since

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Back to the Basics

Two main routes of administration for IV


drug administration services:
Injection
Infusion

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Back to the Basics
Injections
Drugs delivered in one shot
Quickly or over a period of time
Immediate effect
Subcutaneously-under the skin
Intramuscularly-deep into the muscle
Intra-arterially directly into an artery or arteries
Intravenously-directly into a vein
Piggyback-existing IV tube inserted into a vein
IV Push

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Back to the Basics
Infusions:
Administration of IV fluids or drugs
Saline or other solutions
Over a period of time
Therapeutic or diagnostic

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Back to the Basics
Three main categories of drugs and medication:
Chemotherapy
Treats cancer
Non-chemotherapy
Therapeutic
Prophylactic
Diagnostic
Hydration
Electrolytes
Hanging bag with fluids
Sugar and carbohydrates for energy

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Billing Basics
Hierarchy
Pay Attention to CPT guidelines and
instructions
Payer Policies

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What Does CPT Say?
Hierarchy
Applies to facility not clinic setting
Chemotherapy services are primary to therapeutic,
prophylactic, and diagnostic services which are
primary to hydration services. Infusions are
primary to pushes which are primary to injections.

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What Does CPT Say?
Hierarchy
IV pushes are subject to the hierarchy
Subcutaneous and intramuscular injections are not
Do not contain initial in their descriptors
Are not IV services
Overrides parenthetical instructions for add-on codes
Use parenthetical notes in conjunction with the hierarchy
Hierarchy takes precedence

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Chemotherapy IV Infusion

Hierarchy Chemotherapy IV Push

Chemotherapy Injection (IM/SQ)

Non-Chemotherapy IV Infusions

Non-Chemotherapy IV Push

Non-Chemotherapy Injections

Hydration IV Infusion

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Drug Administration Services
Three categories:
Hydration
96360-96361
Therapeutic, prophylactic, diagnostic (Injections and Infusions)
96365-96379
Chemotherapy, High complex drug or biologic agent
96401-96549

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Drug Administration Services
Initial, sequential, and concurrent services
Add-on Codes
Pay attention to the descriptors
Remember IV injection and infusion admin codes are subject to
hierarchy in the facility setting and NOT in office setting

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Initial Services
Professional Services:
Primary reason for the encounter
Regardless of the sequential order in which the injections or infusions are administered
Facility:
Based on hierarchy
Use only 1 initial service code
Unless the protocol or patient condition requires two separate IV
lines to be utilized
The difference in time and effort would be reported using the initial
service code with modifier -59 added

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Sequential Services
IV push or infusion of a new substance or drug following the primary
or initial service
All sequential services require a new substance or drug
Facilities may report a sequential intravenous push of the same drug
using 96376; Therapeutic, prophylactic, or diagnostic injection (specify
substance or drug); each additional sequential intravenous push of
the same substance/drug provided in a facility (List separately in
addition to code for primary procedure)

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Concurrent Services
Infusion of a new drug or substance infused at the same time as another
substance or drug
Not time based
Can only be reported once per day
Regardless of whether an additional new drug or substance is administered concurrently
Hydration may not be reported with any other service
A separate subsequent concurrent administration of another new drug or
substance (3rd substance) is not reported
Multiple infusions of the same drug or substance on the same DOS, the initial
code should be reported
The 2nd or subsequent infusion(s) should be reported based on the individual
time of each additional infusion of the same drug or substance using the
appropriate add on code.

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Important Questions to Ask

Method?
Chemotherapy < 15 minutes
Non-Chemotherapy > 15 minutes
IV Infusion
Injection First hour
IV Injection
Infusion Each additional hour
SubQ
IV Push
Intramuscular
Combination
What did the
Time?
patient receive?

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