Internal Medicine Coding Alert

Question: How should I report IV infusion therapy in the office? I know I am billing incorrectly because reimbursement is extremely low.

Georgia Subscriber

Answer: CPT has two codes for infusion therapy. You should use 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for the first 1-60 minutes of infusion. Use +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) for each additional hour. Code 90781 is an add-on code, which means you can report it only when billing 90780. Bill these codes only when a physician is present during prolonged intravenous injections. Be sure to use the appropriate HCPCS J code for the drug the internist administers.

If the physician also provides a significant, separately identifiable E/M service unrelated to the infusion therapy, you may bill for the E/M service (99201-99215) in addition to the infusion therapy and the drug. Remember to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to indicate that the internist provided a separate service and be sure that the physician's documentation fully supports billing both the visit and the infusion therapy.

Note: The IV setup is not separately payable. This supply item is included in the charge for the visit or other procedures provided at the time of the infusion therapy.


Answers to You Be The Coder and Reader Questions were provided by Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.; Judy Richardson, RN, MSA, CCS-P, a senior consultant at Hill and Associates, a coding and compliance consulting firm in Wilmington, N.C.; and Jean Acevedo, CPC, LHRM, senior consultant at Acevedo Consulting Inc., a national coding and compliance consulting firm in Delray Beach, Fla.