CPT® Coding for Injections and Infusions Continues to Stymie Coders: Here’s Why

Selecting appropriate Current Procedural Terminology (CPT®) codes for injection and infusion can be a daunting task, both for beginners and pro outpatient coders. Outpatient coders must be well versed with the CPT® codes for injections and infusion services provided in both the oncology unit as well as the emergency department (ED), where these types of procedures most often take place.

Appropriate coding is key to data integrity, reimbursement and compliance. But many coding professionals continue to struggle with the demands of CPT® coding for drug administration injections and infusions in the outpatient setting, despite these codes having been around for over eight years. Why?

Complex, Non-Intuitive Terminology and Definitions

Coding for infusions and injections involves terminology that is not intuitive. For example, the drug administration concept of “initial” is highly complex:

  • Only one code in each category of intravenous infusion and injection drug administration codes is designated as the “initial” service.
  • The order of service delivery does not determine what is “initial.”
  • Typically only one “initial service” will be reported per encounter unless there’s more than one IV access site.
  • Hydration can and should be reported with other drug administration services, but it will typically not be reported as the “initial” service.
  • You can’t always rely on the presence or absence of an edit to tell whether your charging/coding is correct or incorrect.

And that’s just one example of the many definitions that a coder must have an excellent understanding of in this area.

Administering Drugs Through Injection/Infusion

When administering drugs through injections/infusions, there are multiple parameters that must be accounted for in CPT coding. The key points below need your attention most.

  • The CPT® coding guidelines for injections/infusions: The CPT® codes 96360 through 96549 code for procedures of administering injections and infusions in the ED, according to AHIMA. Outpatient coders must understand the CPT® guidelines to use these codes.
  • CPT® codes 96360-96361: Hydration infusion
  • CPT® codes 96365-96379: Therapeutic, prophylactic and diagnostic injections and infusions
  • CPT® codes 96401-96549: Chemotherapy administration and other highly complex drug or biologic agent administration
  • The CPT® drug administration hierarchy: Hospitals are required to use the drug administration hierarchy, which is described in the CPT® codebook. Chemotherapy tops the drug administration hierarchy, which is followed by non-chemotherapy drugs and hydration respectively, according to AHIMA:
  • Chemotherapy – Infusion
  • Chemotherapy – IV push
  • Chemotherapy injection
  • Non-chemotherapy therapeutic, prophylactic or diagnostic infusions
  • Non-chemotherapy therapeutic, prophylactic or diagnostic IV push
  • Non-chemotherapy therapeutic, prophylactic or diagnostic injections
  • Hydration infusions
  • Time documentation for time elapsed: Another crucial parameter of administering drugs through injections and infusions is documenting the actual time for when they start and end. This is important because elapsed time, whether it is <15 minutes, 15+ minutes, an hour or more than an hour, corresponds to separate codes for initial, sequential and concurrent infusions, according to AHIMA.

Get Your Codes Right!

In the live webinar “Key Learnings on CPT® Coding of Injections and Infusions,” HIM professional and coding consultant Gloryanne Bryant, RHIA, RHIT, CDIP, CCS, CCDS reviews the CPT® injections and infusion hierarchy and walks through varying injection and infusion scenarios. Gloryanne also reviews code descriptions that help coders understand the application of CPT® coding instructions appropriately.

 

To join the conference or see a replay, order a DVD or transcript, or read more

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