INJECTIONS AND INFUSIONS

1. INJECTIONS AND INFUSIONS Hierarchy of Reporting Sandy Sage R.N.

2. IV INFUSION • A solution delivered at a specific rate, continuously over a period of time. • For infusions up to 60 minutes there is an initial code and for each additional hour there are different codes.

3. IV PUSH An IV push is defined as an injection given with the provider present to observe the patient during an injection or as an infusion < 16 minutes.

4. INITIAL SERVICE • The initial IV service is the service that best describes the primary reason for the visit. • Reported only once per visit UNLESS 2 separate IV sites are used. • Multi-lumen catheters are considered one site.

5. HIERARCHY OF ADMINISTRATION • The “initial service” is not always the first service provided. • The CPT code book gives information on correct reporting in parentheses by each CPT code.

7. HIERARCHY • Non chemo IV infusion would be initial If not then… • Non chemo IV injection would be initial

8. HIERARCHY You would only report an initial hydration service CPT code if it was the only injection or infusion during the visit.

9. HIERARCHY • Chemotherapy Infusion • Chemotherapy Injection • Non-Chemo Infusion • Non-Chemo Injection • Hydration infusion

10. SEQUENTIAL • A sequential IV push or infusion is a substance administered before or after an initial drug administration. • Generally it is an IV push or infusion that is different from the initial drug/substance administered.

11. SEQUENTIAL RULES • Refers to an injection or infusion provided before or after, not during, the initial drug administration. • Should be reported in addition to the initial service. • One CPT code reported per bag or syringe not per medication

12. SEQUENTIAL EXAMPLE A patient in the ER is vomiting and dehydrated. An IV is hung of Normal Saline at 9:45 a.m. for hydration. The patient is also given Zofran IV push for the vomiting at 10:00 a.m. and then again at 11:00a.m. The Normal Saline is stopped at 11:45 a.m.

13. SEQUENTIAL EXAMPLE • Since hydration is never an initial service when administered with anything else it would not be your initial code. • The medications given IV push would be your initial service since no chemotherapy was given.

14. SEQUENTIAL EXAMPLE You would report • (initial IV push) • (sequential IV push of same drug) • (2 additional hours of hydration)

15. NEW FOR 2008 • Prior to January 2008 you were not able to report multiple pushes of the same drug. • You can use 96376 for the same drug if not given until 30 minutes after the first injection of that same drug.

16. ALSO NEW FOR 2008 • The AMA does say that if a drug is only mixed one time and then given in increments, it does not count as a sequential injection. • It has to be prepared each time it is administered.

17. MORE EXAMPLES Patient comes to the ER with Chest Pain. An IV is inserted and patient receives IV push Morphine. The morphine does not relieve the pain so the doctor orders a NTG drip which begins at 11 a.m. and ends at 1 p.m.

18. Example 1 cont. • Since there was no chemo given and there was both an injection and an infusion service, the infusion would be the “initial” service. • 96365 for the first hour • 96366 for the additional hour

19. Example 1 cont. For the IV push of Morphine you would report: • 96375 as a sequential IV push.

20. MULTIPLE RULES If multiple IV drug administrations are given in a single visit you use the hierarchy to determine which infusion or injection should be reported as your initial code.

21. MULTIPLE RULES The other IV drug administration services provided in that visit are reported using the appropriate CPT codes for additional hours, concurrent and/or sequential services, based on the products administered, the method and the length of administration.

22. MULTIPLE MEDICINES It is important to remember that if you give multiple medicines that are combined in one syringe for injection or in one bag for infusion, the injection/infusion are reported as one unit. Don’t report 2 injections or infusions.

23. BILLING EXAMPLE #1 ER patient comes in vomiting. An IV for hydration is hung and infuses for 3 hours. The patient also receives an injection of Phenergan for nausea. How would you report these?

24. BILLING EXAMPLE #1 • 96374 • 96361 X 3

25. BILLING EXAMPLE #2 ER patient receives an antibiotic infusion that lasts 10 minutes. He also has an infusion of Heparin hung that infuses for 3 hours. How would you report these?

26. BILLING EXAMPLE #2 • 96374 • 96366 X 3

27. BILLING EXAMPLE #2 • 96365 • 96366 X 2 • 96375

28. REVIEW

29. CONTACT INFORMATION EMAIL Sandy.Sage@HCAhealthcare.com