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Coding Injectionsand InfusionsAudio Seminar/WebinarJanuary 31, 2008Practical Tools for Seminar Learning Copyright 2008 American Health Information Management Association. All rights reserved.

DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein and specificallydisclaims any implied guarantee of suitability for any specific purpose. AHIMA hasno liability or responsibility to any person or entity with respect to any loss ordamage caused by the use of this audio seminar, including but not limited to anyloss of revenue, interruption of service, loss of business, or indirect damagesresulting from the use of this program. AHIMA makes no guarantee that the useof this program will prevent differences of opinion or disputes with Medicare orother third party payers as to the amount that will be paid to providers of service.CPT five digit codes, nomenclature, and other data are copyright 2007 AmericanMedical Association. All Rights Reserved. No fee schedules, basic units, relativevalues or related listings are included in CPT. The AMA assumes no liability for thedata contained herein.As a provider of continuing education, the American Health InformationManagement Association (AHIMA) must assure balance, independence, objectivityand scientific rigor in all of its endeavors. AHIMA is solely responsible for control ofprogram objectives and content and the selection of presenters. All speakers andplanning committee members are expected to disclose to the audience: (1) anysignificant financial interest or other relationships with the manufacturer(s) orprovider(s) of any commercial product(s) or services(s) discussed in an educationalpresentation; (2) any significant financial interest or other relationship with anycompanies providing commercial support for the activity; and (3) if thepresentation will include discussion of investigational or unlabeled uses of aproduct. The intent of this requirement is not to prevent a speaker withcommercial affiliations from presenting, but rather to provide the participants withinformation from which they may make their own judgments.The faculty has reported no vested interests or disclosures regarding thispresentation.AHIMA 2008 Audio Seminar Seriesi

FacultyLori Purcell, RHIA, CCSAs Director of Coding and Reimbursement for QHR, Ms. Purcell assists health careorganizations with improving and monitoring the quality of coding and documentationto secure appropriate reimbursement. Ms. Purcell has extensive experience in ICD-9CM and CPT-4 coding for hospitals. Ms. Purcell’s passion lies in knowledge transfer.She develops and presents seminars based on needs identified through her consultingwork. She has leveraged her 27 years of coding specific experience to developtraining materials and services assisting hospitals to improve the accuracy of codingand documentation. She conducts workshops to ensure hospitals are up-to-date on theever-changing healthcare environment. Ms. Purcell led the development of QHR’sCoding Community website, allowing hospitals to continue building their knowledgebase.AHIMA 2008 Audio Seminar Seriesii

Table of ContentsDisclaimer . iFaculty .iiIntroduction . 1Initial ServiceMore than one initial or primary service. 1Practice Makes Perfect. 2Coding Second or Subsequent Service. 3Hydration Services . 6Infusion Services. 6Services Integral to a Procedure . 7Reporting Services Started Outside the Hospital. 8Additional Services . 9Reporting E/M Visit.10Reporting Irrigation of CVA Device with Injection or Infusion .10ChemotherapySequential Drug Administration.11Examples.12Coding Vignette #1 .15Coding Vignette #2 .15Coding Vignette #3 .16Faculty Information .16Resources .17Audience QuestionsAppendix.20CE Certificate Instructions .21AHIMA 2008 Audio Seminar Series

Coding Injections and InfusionsNotes/Comments/QuestionsThe initial service is the code thatbest describes the key or primaryreason for the encounter 96413 Chemotherapy infusion96409 Chemotherapy IV push90765 Infusion90774 IV push90760 Hydration1Sometimes it’s OK to have morethan one initial or primary servicecode8:00 AMIV # 1IV #24:00 PMSeparate siteSeparate encounter2AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved1

Coding Injections and InfusionsNotes/Comments/QuestionsPractice Makes PerfectA patient presents with complaintsof abdominal pain. An IV is startedat KVO as a precautionary measure.Diagnostics are completed and thephysician orders an IV antibiotic tobe infused over 30 minutes.The primary service is:A. ChemotherapyB. InfusionC. InjectionD. Hydration3Practice #2The same patient presents withabdominal pain. The patient isclinically dehydrated andhydration is given at 200 cc/hr.After the hydration, an IV infusionof antibiotics is given.The primary service is:A. ChemotherapyB. InfusionC. InjectionD. Hydration4AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved2

Coding Injections and InfusionsNotes/Comments/QuestionsPractice #3A patient presents with low bloodpressure and tachycardia. Two IVsare started. A two liter bolus isgiven with minimal improvement.A dopamine drip is started in oneline and the bolus continued inthe other.The primary service is:A. ChemotherapyB. InfusionC. InjectionD. Hydration5Once the primary service has beenestablished, second or subsequentservices are coded separately 96417 Chemotherapyinfusion96411 Chemotherapy IVpush90767 Infusion90775 IV push new drug90776 IV push same drug90761 Hydration6AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved3

Coding Injections and InfusionsNotes/Comments/QuestionsThere are different codes for IVpush of the same substance and anew substanceIV push of Demerol at 10:00 IV push of Demerol at 10:45 90774 and 90776IV push of Demerol at 10:00 IV push of Reglan at 10:05 90774 and 907757IV injectionsrequire thehealthcareprofessionalto becontinuouslypresent toadministerthe injection8AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved4

Coding Injections and InfusionsNotes/Comments/QuestionsA concurrent infusion occurs whenmultiple infusions are providedsimultaneously through the sameintravenous line90768 Concurrent infusion(List separately in addition tocode for primary procedure)990765 for the first antibiotic90768 for the concurrent infusion of antibiotic90775 for the sequential IV push drug10AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved5

Coding Injections and InfusionsNotes/Comments/QuestionsHydration Servicesmust be therapeutic90760 Intravenous infusion, hydration; initial,31 minutes to 1 hour90761 Intravenous infusion, hydration; eachadditional hour (List separately inaddition to code for primary procedure)(Report 90761 for hydration infusion intervalsof greater than 30 minutes beyond 1 hourincrements)(Report 90761 to identify hydration if providedas a secondary or subsequent service after adifferent initial service [90760, 90765, 90774,96409, 96413] is administered through thesame IV access)(Do not report intravenous infusion for hydrationof 30 minutes or less)11There is a HCPCS code forinfusion services C8957 Prolonged IV infusion,requiring pump12AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved6

Coding Injections and InfusionsNotes/Comments/QuestionsTo code correctly, you must havedocumentation of the time forinfusion and hydration servicesFirst hour infusion 16 minutes or moreFirst hour hydration 31 minutes or moreSecond hour first 60 minutes plusadditional 31 minutes or more13Drug administration services thatare integral to a procedure are notreported separately14AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved7

Coding Injections and InfusionsNotes/Comments/QuestionsHospitals may reportinfusions that are startedoutside the hospital15Some services included indrug administration codes are notreported separately with CPT codes Use of local anesthesiaIV startAccess to indwelling IV, subcutaneouscatheter or portFlush at conclusion of infusionStandard tubing, syringes andsupplies16AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved8

Coding Injections and Infusions90772 Subcu orintramuscularinjection isconsidered acomponent ofinfusion codesand will requiremodifier 59Notes/Comments/QuestionsCodes 90760,90765, 96401,96402, 96409,96413 90772 Modifier 5917Here are some additional servicesyou may want to include 90471 Single vaccineadministration 90472 Each additionalvaccine G0008 Influenza G0009 Pneumococcal G0010 hepatitis B(CAH only) 92977 Coronarythrombolysis byintravenous infusion 36000 IV Start (do notuse with any IV drugadministration service) 36430 Bloodadministration (perencounter)18AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved9

Coding Injections and InfusionsNotes/Comments/QuestionsDo not report an E/M visitcode if the reasonfor the visit was toadminister drugs19Do not report 96523 if an injectionor infusion is provided on thesame day96523 Irrigationof implantedvenous accessdevice for drugdelivery systems20AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved10

Coding Injections and InfusionsNotes/Comments/QuestionsChemotherapy codesfollow most of thesame codingguidelines as drugadministration codes21Report drug administration givensequentially with apyinjections 90775 90775Hydration forone hour 9076122AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved11

Coding Injections and InfusionsNotes/Comments/QuestionsChemotherapy services includenon-radionuclide anti-neoplasticdrugs, anti-neoplastic agents fortreatment of noncancerdiagnoses andsubstances suchas certainmonoclonalantibody agentsand other biologicresponse modifiers23SECTION I - PRIMARY SERVICESPrimaryservicesStart andstop timesNursingOnly ONE of the following primary services may be billed perencounter, unless the patient has two separate IV sites. Theprimary charge is selected based on the service which bestdescribes the reason for the visit. Once one of the followingis selected, any additional services should be billed using thecharges listed in Section II or Section III below.IV IV#1 #2IV Drug Infusion - 90765 (INFUSION of IV Meds givenover 16 minutes or more, i.e. piggyback, mini-infusor,etc). YOU MUST DOCUMENT START AND STOP TIMESWITH THIS SERVICE.3780IV Push Med - 90774 (Med is given IV Push OR theinfusion of the Med is 15 minutes or less in duration)3781IV Hydration Therapy - 90760 (Prepackaged IV fluidsand electrolytes with no other drugs or substancesadded. Use this charge when the primary reason forthe visit is hydration and fluids are infused for morethan 30 minutes.) YOU MUST DOCUMENT START ANDSTOP TIMES & RATES OF INFUSION WITH THIS SERVICE.DO NOT use this charge for KVO or TKO rates ofinfusion or for Heparin or Saline Locks.3782Not for KVO, TKO, saline lockAHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved2412