Infusion and Injection Coding-Part 5

For the past several months “Spotlight on CPT” has presented information for coding of injections and infusions. This final installment on this topic will present several scenarios as well as the rationale for code assignment.

When coding for infusions and injections, it can help coding professionals to assign the correct codes if they ask two questions? What is the primary (initial) service, and are there any other services that should be captured?

Let’s look at this example.

A patient is receiving a 2 mg/mL IV of Zithromax for treatment of her community-acquired pneumonia. It runs from 11:34 -1:04 as an IVBP in Normal Saline (0.9% sodium chloride).

What code(s) should be assigned?

96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis, initial, up to 1 hr.

This is the only code that should be assigned. The total time of the infusion was 90 minutes. Criteria is met to assign 96365 but not the add-on code for an additional hour since the infusion did not run more than 30 additional minutes. Remember that no code for the hydration fluid should be assigned as it is the mechanism for the drug administration.

Here’s another example.

An IV infusion runs for 43 minutes. Twenty minutes later, an IV push of the same medication is performed. The coding was assigned as follows:

96365-IV infusion; initial, up to 1 hr.

96376-IV push, each additional sequential IV push of same substance/drug

Is this correct? No, not enough time elapsed between the infusion and the push to be permitted to code for the push (needed to be at least 31 minutes). The only code that should be assigned is 96365 for the infusion.

Example:

A patient come to the ER at 10:30 p.m. The physician is concerned the patient may be septic, and an IV line is established immediately with fluid TKO. He gets a push of antibiotic at 10:48 p.m. over 12 minutes. Patient goes to observation at 12:45 a.m. At 1:10 a.m. the patient gets another IVP of the same medication again for 12 minutes. How should this be coded?

96374 IV push; single or initial substance/drug

+96376 IV push each sequential IVP of the same substance/drug provided in a facility

These are the correct codes. Remember, this would not be considered two initial services since ER to observation is just one encounter. Also, the fluid administration cannot be separately coded since it was given to keep the line open.

Now, light has been shed on coding injections and infusions.

 

About the Author

Dianna Foley, RHIA, CHPS, CCS, CDIP, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as Eastern Gateway Community College’s program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.