Time Makes the Difference on Multi-Substance Infusion Claims
Published on Sat Jan 05, 2008
Observe minimum infusion time on all codes
When your pulmonologist infuses a patient with multiple substances during the same session, you'll also need to know which infusion payers consider primary, or the claim could wind up being inaccurate. Further, you need to be sure to code for the proper type of secondary infusion, or you could risk denials.
Check out this expert advice on making the most of your multiple-substance infusion claims.Code 'Initial' Infusion FirstWhen coding multiple-substance infusion claims, report the initial infusion with 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour). If the initial infusion lasts more than an hour, include +90766 (... each additional hour [list separately in addition to code for primary procedure]) for each additional infusion hour, says Sarah L. Goodman, MBA, CPC-H, CCP, president and CEO of SLG Inc. in Raleigh, N.C.
Remember: In order to rightfully report 90765-90766, the session must meet the following requirements:
• The pulmonologist must be administering the infusion for therapeutic, prophy- lactic or diagnostic purposes.
• The pulmonologist must supervise the entire session.
• The infusion must last a minimum of 16 minutes.
• The infusion must not be an inherent component of another procedure, such as a CT scan.
• A healthcare professional must be in attendance during the entire session.Note: Payers will deny any 90766 claim for less than 30 minutes of infusion time. For example, if a patient receives a 75-minute therapeutic infusion, you can report only 90765; you won't be able to account for the 15 minutes of infusion past the hour mark.
However, if the patient receives an infusion of a single drug that lasts one hour and 45 minutes, the physician would report 90765 for up to one hour and 90766 for the additional 45 minutes.
'Initial' drug is not always first: Payers consider the initial infusion the "main reason" the patient is seeing the pulmonologist, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga. The initial infusion is not necessarily the first drug the pulmonologist administers.
"The chronological order of the drugs, medications and/or substances infused is not important--what is critical is the primary reason for the patient to be there that day," Parman says.Hierarchy Comes in Handy for Infusion Sessions
As a guide, Goodman uses this "unofficial hierarchy" of infusion services she culled from the APC Weekly Monitor. This list could come in handy when deciding how to code multiple infusion claims:
• chemotherapy infusions
• chemotherapy injections
• non-chemotherapy, therapeutic infusions
• non-chemotherapy, therapeutic injections
• hydration infusions."Regardless of the order in which the physician administers the infusions, report the 'initial' code for the service that falls highest on the (hierarchy) list," Goodman says.
Example: The patient presents to the pulmonologist's office for chemotherapy treatment, and the pulmonologist performs a therapeutic, non-chemotherapy infusion of antibiotics. [...]
