Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 17, 2005 PDF

AMA adds category for hormonal agents to drug administration codes

If you're struggling to come to grips with the new drug administration CPT codes for 2006, you can get a head start with the following primer.

The basics: The American Medical Association has released the section of the 2006 CPT Updates including the codes for drug administration. The new codes are similar to the "G" codes you've been using for drug administration this year, but some concepts are spelled out in more detail.

Key idea: The new update includes more about the concepts of "initial," "subsequent" and "concurrent" infusion, says Kristi Downey, practice manager with Grand Rapids, MI Ob-Gyn physician Gary Downey. You can only have one initial service per encounter, unless you have two different IV sites.

If you provide a patient with an hour of infusion followed by an IV push, you should bill for the IV push using a subsequent IV push code ...quot; even though it's the first push you're providing, the AMA explains.

It's important to bear in mind that the initial code isn't necessarily (or even usually) the first drug you administer, Downey stresses. The initial code is the primary reason for the encounter, so for a chemotherapy service, the main chemotherapeutic drug will be your initial infusion code.

Codes: The new codes break out some specific drugs, such as hormonal agents (90772 and 94602) that didn't have their own category before. They contain hydration codes (90760-90761) that correspond to this year's "G" codes. The AMA clarifies that an IV push is less than 15 minutes and requires a health care professional to be continuously present. Chemotherapy drugs include anti-neoplastic agents used for non-cancer diagnoses.

The new codes use the same time breakdown as the "G" codes, including the first hour, followed by each additional hour. Each additional hour must be 31 minutes or more, Downey cautions. You bill for more than eight hours as "prolonged infusion." You should use the actual time over which you administer infusion to report time-based codes.

To find the drug administration codes, go to www.amaassn.org/ama/pub/category/3113.html and click on "2006 drug administration codes" under "What's New."