Practice Management Alert

Watch out:  CPT has revamped its injection, infusion sections

Medical offices that report last year's CPT codes for injection and infusion should expect denials for those claims. 

Why? CPT has completely overhauled the reporting methods for both procedures. When a biller reports an injection and infusion, she needs to forget about last year's codes and get used to a bunch of new ones. Further, 2006 is the first year that hydration procedures have their own code set, ending the practice of reporting hydrations with infusion codes.

Read on for the lowdown on what's been added to--and deleted from--CPT to represent infusions, injections and hydrations.

Answer:   When billing infusions, you should scrap last year's code set, 90780 (Intravenous infusion for therapy ...) and +90781 (... each additional hour), said Michael Granovsky, MD, CPC, FACEP, vice president of MRSI, a medical billing company in Stoneham, Mass., during a recent Coding Institute teleconference.

On your infusion claims, you should choose from the following codes:

- 90765--Intravenous infusion, for therapy, prophylaxis or diagnosis (specify substance or drug); initial, up to 1 hour
- +90766--- each additional hour, up to 8 hours (list separately in addition to code for primary procedure)
- +90767--... additional sequential infusion, up to 1 hour (list separately in addition to code for primary procedure)
- +90768--- concurrent infusion (list separately in addition to code for primary procedure).

Remember: You must note on the chart that the physician directly supervised the infusion session, Granovsky says.

For Injections, Choose From a Quintet of New CPT Codes

Injection reporting is also different this year. According to CPT, the following five codes are no longer valid:

- 90782--Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular
- 90783--... intra-arterial
- 90784--- intravenous
- 90788--Intramuscular injection of antibiotic (specify)
- 90799--Unlisted therapeutic, prophylactic or diagnostic injection.

On your injection claims, you should choose from these codes instead:

- 90772--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
- 90773--- intra-arterial
- 90774--... intravenous push, single or initial substance/drug
- +90775--... each additional sequential intra-venous push of a new substance/drug (list separately in addition to code for primary procedure)
- 90779--Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion.

Example: An established patient with anemia comes in for his monthly injection of vitamin B-12. On the claim, you should report 90772 for the injection.

Remember that any intravenous or intra-arterial push sessions require a healthcare provider's continuous presence to observe the patient, Granovsky said. Also, be sure to choose a code from this set when the physician performs an infusion that lasts less than 15 minutes.

Hydration Gets Its Own Codes

In addition to the infusion and injection coding changes, hydration coding will also be different from now on. In previous years, you would report hydration with the infusion codes 90780 and 90781.

But now, hydration procedures have their own code set, says Kevin Arnold, CPC, a coding instructor with Health Information Services Outpatient Coding in Danbury, Conn.

On your hydration claims:

- report 90760 (Intravenous infusion, hydration; initial, up to one hour) for the first hour of hydration.
- report +90761 (... each additional hour, up to 8 hours [list separately in addition to code for primary procedure]) for each additional hour.

Example: The physician sees a patient with signs of dehydration. During the encounter, the physician discusses IV fluid rehydration with the patient, establishes an IV and administers a normal saline (NS) solution bolus of 20 ml/kg, at which point the patient's condition stabilizes.

The total hydration time is 50 minutes. To report this infusion, you would use 90760, since it involves a hydration process.

Watch for these bundles: If you are reporting an injection/infusion/hydration session, Arnold advises against coding for any of the below materials/services, since they are considered part of any injection/infusion/hydration service:

- Use of local anesthesia
- IV start
- Access to indwelling IV, subcutaneous catheter or port
- Flush at conclusion of infusion
- Standard tubing, syringes and supplies.

Remember: During most injection or infusion sessions, the physician performs a separate evaluation and management service as well.

For information on securing separate E/M payment during an injection or infusion session, see -You Can Get Separate E/M Pay on Injections, Infusions- above.