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Recognize Infusion Administration Types to Ensure Proper Payment

Coding infusions is far from run-of-the-mill, and if you don’t get it right, you’ll likely see reduced — if not denied — claims. One of the key concepts when reporting this service is understanding the type of infusion you’re providing. Get it right, and your claim sails through, but get it wrong, and you’ll be chasing the payments you deserve.

There are four types of infusion administrations that affect your code choice:

  1. Initial— This is the key or primary reason the patient is receiving infusion, regardless of the order in which she receives medications. For instance, if the patient receives 1 hour of pre-chemotherapy medication (such as an antiemetic, antibiotic, etc.) before 3 hours of chemotherapy infusion, you would report the chemotherapy as the initial infusion because that is the reason the patient is present for therapy.
In addition, you can report only one “initial” service code per patient visit, unless the patient requires two separate IV access sites. If that’s the case, then you would report two initial services codes with modifier 59 (Distinct procedural service) attached to the second code (for example, 96413 and 96413-59). In most cases, however, you’ll likely only have one initial service.
  1. Sequential— Sequential infusions include any infusion or IV push of a new substance following a primary or initial service. So, this would cover the pre-chemotherapy medication infusion, for example. Generally, the sequential service must involve a new substance or drug. However, a facility may report a sequential intravenous push of the same drug with +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)), CPT® says.

In the example above of the pre-chemo infusion, you would likely report this as a sequential infusion with +96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)).

  1. Concurrent — A concurrent infusion is the infusion of two unique substances or drugs at the same time. This is not a time-based service, and you can report it only once per day. For instance, you can report +96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)) only once per date of service.

Further, you can’t count hydration as a concurrent infusion with any other service. And even if the patient receives multiple concurrent infusions of new drugs or substances (a third or fourth medication, for example), you can report only one concurrent infusion for each day.

  1. Push — In addition to the infusions listed above, there’s also the “push,” which has two definitions:
    • An infusion that lasts 15 minutes or less; or
    • An injection during which the administrator is continuously present to provide the injection and observe the patient.

When it comes to a “push” infusion, the time factor is important to note here. If an infusion lasts 15 minutes or less, then you’ll use a push code — such as 96420 (Chemotherapy administration, intra-arterial; push technique) — rather than an infusion code.

Keeping all the infusion administration routes straight is no picnic. And when you add in all the types of medications, timing and settings that you must track to properly code these services, the challenges only multiply. But by recognizing the type of administration, you can narrow your choices appropriately and nail down the correct code to submit the first time.

 

Take Aways:

  • For initial infusion coding, look for the main reason the patient is receiving service rather than the first substance infused.
  • Sequential infusions can be almost anything, including more chemotherapy medications or prophylactic and therapeutic drugs. So pay close attention to the infused material.
  • You can report only one concurrent infusion per date of service, regardless of the number of substances infused.
For more strategies for effective infusion coding, check out Coding Leader’s online training session — Injections and Infusions: Code More Accurately, Get Paid More. And you can view all upcoming live online training sessions at  https://codingleader.com/pages/online-training-calendar.

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