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Injections and infusions

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    Medical Coding Books
    Quote Originally Posted by LTibbetts View Post
    eadun200, you're right I just got off the phone with a coding consulting firm that we sometimes work with and that is exactly what they explained to me. The injections are going to be the death of me...aarrgghhh!

    Deb, doesn't the heirarchy state that the IV push trumps the hydration? Even if the pt comes in for dehydration? This is where I get confused. I can't find anything in writing anywhere to back this up and my supervisor is saying that it trumps no matter what. Now she is telling me that we can charge the 96361 even if they don't have hydration is for under 31 minutes. That one, I completely disagree with. Am I wrong again? Help...
    You are 1000% right! Say, for instance, a patient comes in with dehydration but fell and hurt his hip (I know stretching it, but just bear with me). They started hydration for the dehydration and gave a dilaudid push. It would be coded 96374 and 96361 (granted the hydration was a minimum of 31 minutes in length). However, if the hydration was less than 30 minutes, you cannot code it regardless! It cannot happen. I hope this helps

  2. #12
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    The hierachy again is for the facility coding as I already pointed out even n the CPT book it states for the physician you use as the initial code the one which fits the reason for the infusion so in the example above you would use initial hydration followed by the susequent push. and if you want to list the push first then fine but you still use the subsequent push code then the initial hydration code. This is from the CPT book. But I know I have something else also I just need time to persuse my data base.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Quote Originally Posted by mitchellde View Post
    The hierachy again is for the facility coding as I already pointed out even n the CPT book it states for the physician you use as the initial code the one which fits the reason for the infusion so in the example above you would use initial hydration followed by the susequent push. and if you want to list the push first then fine but you still use the subsequent push code then the initial hydration code. This is from the CPT book. But I know I have something else also I just need time to persuse my data base.
    Was she not talking about ED facility? I was under the impression that she was... not pro side.

  4. #14
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    No Leslie works on the pro side.

    Debra A. Mitchell, MSPH, CPC-H

  5. #15
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    Yes, I do work on the pro side but recently we have been asking to take over the facility billing for the injections and infusions as the staff upstairs is not educated in coding and we are ending up fixing all of their mistakes anyway, so we may as well enter them ourselves to save all of the running around.

    Deb, you still answered my questions, though, because I did need to know who the heirarchy affects and if it is the facility or not. I am actually coding one right now that came in w/ gastroenteritis and received 2 hrs of hydration before admitted. He also received an IV med, so I use the initial code since this is for the facility side, 96374 and then the 96361x2, right? The other issues we are dealing with here is using the -59 modifier with the IV hydration when the patient has a CT done. That can only be the case when the patient has a CT w/out contrast, correct? So, if this pt came in and had a CT w/no contrast, IV drugs x 2, then I can code the CT, 96374-59, and 96375, right? I hate to mess with the -59. What if the pt does have a CT w/contrast but the IV was put in in the ER and the pt received drugs also? Can I use the -59 in this case?

    I can't believe how confusing this is. I think I may be starting to get it, though, so thanks everyone for helping me with this. I'm sure it is redundant to you, so I appologize. I need to hear input multiple times before it seems to conceptualize in the head, I guess.
    Last edited by LTibbetts; 03-16-2010 at 09:29 AM.

  6. #16
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    HYdration before push according to the facility hirearchy. A therapeutic infusion over hydration so in most cases a push will almost always be subsequent. Exception... lets say we put in a hep lock or even a main line for the purpose of giving IVpush meds, the the IVpush is initial. So in the example you have givven it would be the
    96360
    96361
    96375
    for the CT patient I would not think you need a 59 modifier but I have not checked CCI edits lately, so I would see if the 96374 is bundled and if not then no modifier.
    for 2 pushes if they are different meds the 96374 and 96375 if it is the same drug pushed twice in the facility setting 96374 and 96376 If we are adding this to the hydration scenario then
    96360
    96361
    96375
    96375 59 (second push new drug)
    96376 (second push same drug.

    In my CPT book it says that Hydration trumps the push I gave you the quote right out of my book, I check several other sources and they all say the same thing... I am wondering does someone elses book say something different?

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    Quote Originally Posted by mitchellde View Post
    HYdration before push according to the facility hirearchy. A therapeutic infusion over hydration so in most cases a push will almost always be subsequent. Exception... lets say we put in a hep lock or even a main line for the purpose of giving IVpush meds, the the IVpush is initial. So in the example you have givven it would be the
    96360
    96361
    96375
    for the CT patient I would not think you need a 59 modifier but I have not checked CCI edits lately, so I would see if the 96374 is bundled and if not then no modifier.
    for 2 pushes if they are different meds the 96374 and 96375 if it is the same drug pushed twice in the facility setting 96374 and 96376 If we are adding this to the hydration scenario then
    96360
    96361
    96375
    96375 59 (second push new drug)
    96376 (second push same drug.

    In my CPT book it says that Hydration trumps the push I gave you the quote right out of my book, I check several other sources and they all say the same thing... I am wondering does someone elses book say something different?
    In my 2010 CPT book for facility it states "When these codes are reported by the facility, the following instructions apply. The initial code should be selected using a hierarchy whereby chemotherapy services are primary to theraputic, prophylactic and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy is to be followed by facilities and supersedes parenthetical instructions for add-on codes that suggest an add-on code of a higher hierarchical position may be reported in conjunction with a base code of a lower position. (For example, the hierarchy would not permit reporting 96376 with 96360, as 96376 is a higher order code. IV push is primary to hydration.)

    That being said, on the facility side, it is always chemo, followed by infusions, followed by pushes, followed by hydration. However, the only time that I can think of that a hydration is billed primary with an injection is if it is given IM or SQ. In that case, the hydration is primary. Otherwise, it is pushes that are primary.

    On the modifier 59 issue, the only time I have ever had to put a modifier 59 on any of the infusions, injections, hydrations is if there is another procedure done; ie chest tube, foley cath, NG tube, etc. I for the life of me cannot figure out why we have to do it on the foley cath, but it is on the CCI edits so we do it I have never had to do it because of a CT with contrast or not. I really hope this helps

  8. #18
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    Deb, in a CPT Ingenix book it states
    "96360-96361 IV fluids infusion for hydration:
    hierarchy rules for facility setting only:
    Diagnositc, prophylactic and theraputic svcs are primary to hydration, Chemo is primary to that, infusions are primary to pushes and pushes are primary to injections."

    But as you said before, this is for the faiclity setting. This is a co-workers book and I just found it. The CPT book phrases it differently and maybe that is why I am confused. It does say under the hydration section that the hydration codes are facility reporting only. The same statement is made under the 96365 code set. It also states that if meds are given IV, then the hydration is not seperately reportable.I think that was the source of most of my confusion, especially when pts are coming in specifically to be hydrated but are also receiving zofran, for example. Does this sound right to you?

  9. #19
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    Leslie in both your post and the one above it states that "chemo is primary to therapeutic" OK we all agree on that. Then it says " infusions are primary to pushes, which are primary to injections." No where in either post does it state that pushes are higher than hydration, Hydration is an infusion so when it says infusions are primary to pushes it includes hydration. My book clearly makes the statement that hydration goes before pushes. I do not want to belabor this but it is important to be correct and I think maybe somewhere too much is being read into this. I looked up several other resources and all said the same thing that hydration goes before pushes.

    Now as far as hydration being separately reportable, it definitely is but you clearly need a dx that will support it, if you started a primary fluid for the purpose of administering push meds then you may not bill the primary fluid as hydration and this happens frequently. If you can support with documentation and dx that hydration was therapeutic and then we administered push meds then yes you may bill both.
    I have to go with this being the hirearchy until someone can come forth with a better reference that specifically states that push goes before hydration but I do not feel that either of these other references do that.

    Debra A. Mitchell, MSPH, CPC-H

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