Page 1 of 2 12 LastLast
Results 1 to 10 of 19

Injections and infusions

  1. #1
    Default Injections and infusions
    Medical Coding Books
    We are having yet another injection debate in the office and I was hoping to get feedback on this. I code for a small rural ER and I code the pro fees. The facility fees are done by a unit secretary in the ER and they do it by CDM, not CPT. No one up there is a coder and they don't even see CPT codes so we are having to clean up their messes constantly and hopefully, we are finally going to be able to do it ourselves soon.

    The biggest problem is the hydration issue. They are constantly putting two initial codes on there, one for initial hydration and one for initial drug pushes. Now I realize that you are only allowed one initial per chart and we have told them that. But what about patients that come in with gastroenteritis or dehydration and get hydrated and then recieve drugs via IVP. Now, according to the heirarchy, as soon as they receive drugs, the hydration becomes incidental. Isn't that correct? But is that the case even when the patient comes in for dehydration? The patient also got Zofran, and fentanyl, which again, is related to the reason the patient is here in the first place...belly pain, N&V, dehydration, etc.

    My supervisor wants to charge for both the infusion and the drug and have us put a -59 modifier on it because she says it's two different things. You just can't get around the initial code rule so I don't know how it could work. I don't agree and furthermore, I am hesitant to mess with that -59 code. I know how abused and overused it is. Can anyone help me with this?

  2. Talking
    you are absolutely correct in your knowledge of the heirarchy of the infusions. The only way to charge 2 initial's is if there are 2 distinct sites for infusion...therefore if the patient is having an infusion in both arms (example) then you can charge for both initials...
    It was explained to me like this:
    an IVPB is the KING and he is always in charge no matter when he enters the room (the initial charge)
    the IVP is the QUEEN and she is second and can only be the in-charge (initial) if the KING is not around (if a piggy-back was never administered)
    the hydration is the PRINCE and he can only be in-charge (initial) if the KING and QUEEN are not around...and have never entered the room ...
    sounds a little silly, but it really helped me keep the heirarchy in order...

    if there are 2 kingdoms (two seperate identifable areas of infusions) then and only then can you have another KING/QUEEN/PRINCE

    good luck explaining that to your supervisor without her thinking you are a little bizarre!!

  3. Default
    Quote Originally Posted by LTibbetts View Post
    We are having yet another injection debate in the office and I was hoping to get feedback on this. I code for a small rural ER and I code the pro fees. The facility fees are done by a unit secretary in the ER and they do it by CDM, not CPT. No one up there is a coder and they don't even see CPT codes so we are having to clean up their messes constantly and hopefully, we are finally going to be able to do it ourselves soon.

    The biggest problem is the hydration issue. They are constantly putting two initial codes on there, one for initial hydration and one for initial drug pushes. Now I realize that you are only allowed one initial per chart and we have told them that. But what about patients that come in with gastroenteritis or dehydration and get hydrated and then recieve drugs via IVP. Now, according to the heirarchy, as soon as they receive drugs, the hydration becomes incidental. Isn't that correct? But is that the case even when the patient comes in for dehydration? The patient also got Zofran, and fentanyl, which again, is related to the reason the patient is here in the first place...belly pain, N&V, dehydration, etc.

    My supervisor wants to charge for both the infusion and the drug and have us put a -59 modifier on it because she says it's two different things. You just can't get around the initial code rule so I don't know how it could work. I don't agree and furthermore, I am hesitant to mess with that -59 code. I know how abused and overused it is. Can anyone help me with this?
    You can code injections with hydrations. The primary code would be 96374. For the hydration, you would code it as secondary with a 96361. Just remember that infusions come first, followed by injections followed by hydration. For example, you had an infusion of Avelox for 32 minutes, an IVP of Toradol and Phenergan and an hour of hydration. It would be 96365; 96375 x2 and 96361.

  4. #4
    Default
    eaudun2000, thank you but I thought you should know that the 96361 is an add-on code and can only be used when the primary procedure code, 96360, has been used, it can not be used as a "subsequent code" without a parent code, but thank you for your response anyway.

    Alicm, thank you so much!! I thought that story was pretty funny, actually, and I can't tell you how much easier that will be for me to remember. It's funny the things that stick with you, isn't it? Just one more thing, though, if you don't mind. What about the case of the patient here for only hydration and ends up getting zofran for the nausea, is it the same royal explanation? And also, do you know if there is anything about this specific topic on the CMS website and where to find it? I've searched but am not having much luck. Thanks again

  5. #5
    Location
    Columbia, MO
    Posts
    12,844
    Default
    Quote Originally Posted by eadun2000 View Post
    You can code injections with hydrations. The primary code would be 96374. For the hydration, you would code it as secondary with a 96361. Just remember that infusions come first, followed by injections followed by hydration. For example, you had an infusion of Avelox for 32 minutes, an IVP of Toradol and Phenergan and an hour of hydration. It would be 96365; 96375 x2 and 96361.
    Leslie is correct, you must code the initial as the initial reason the patient received the fluids, in this case the hydration is the initial and the push is subsequent. I liked the king, queen . prince story though that is priceless!

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Quote Originally Posted by LTibbetts View Post
    eaudun2000, thank you but I thought you should know that the 96361 is an add-on code and can only be used when the primary procedure code, 96360, has been used, it can not be used as a "subsequent code" without a parent code, but thank you for your response anyway.

    Alicm, thank you so much!! I thought that story was pretty funny, actually, and I can't tell you how much easier that will be for me to remember. It's funny the things that stick with you, isn't it? Just one more thing, though, if you don't mind. What about the case of the patient here for only hydration and ends up getting zofran for the nausea, is it the same royal explanation? And also, do you know if there is anything about this specific topic on the CMS website and where to find it? I've searched but am not having much luck. Thanks again
    LTibbetts,

    Just as an FYI, yes 96361 is an add on code, but is to be used with a primary.. primary is either 96365 (infusion) 96374 (injection) or 96360 (hydration). It did not make sense to me for the longest time of why you have to use 96361 without the 96360, but if you look in the CPT book it explains that 96361 is an add on code for above three codes. I do know that infusions are listed first, followed by injections, followed by hydrations.

  7. #7
    Default
    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...

  8. #8
    Location
    Columbia, MO
    Posts
    12,844
    Default
    I believe that on the AMA web they state that you use the initial service as the reason for the infusion so the hydration is the intial code. The hirearchy is for facility billing and not the physician. Also you are correct if the hydration is less than 30 minutes thenit is not billable and the reson is that if it is less than that then it is not therapeutic and cannot be dehydration. I will check on what I have but I know this is stated somewhere.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Location
    Columbia, MO
    Posts
    12,844
    Default
    Leslie in the CPT book it states:
    "When reported by the physician, report the 'initial' code that best describes the primary reason for the encounter regardless of the order in which the infusions or injections are administered.
    When reported by the facility the 'initial' code should be reported in the order of chemotherapy services followed by therapeutic/prophylactic/diagnostic services, followed by hydration services, followed by infusions, followed by pushes, and finally injections."
    Therefor if the reason for the infusion was for hydration then that is your initial code, but if it does not run for at least 31 minutes then per the rules you may not report the infusion.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default
    Thank you so much, Deb!! I just brought this post into my supervisors office and showed her. If you do happen to come across anything in writing anywhere, can you please send the link to me? She is still being a little sketchy about it. She is still thinking that we can charge that subsequent hydration code if under 31 minutes, since we miss out on the intitial hydration code because of the IV push. I told her it was fraud and that I would refuse to do it and she could if she chose to but I don't want anything to do with it. I told her that timed codes are just that..timed codes...but she is taking advice from someone else now.

    We are taking over the facility coding for injections and infusions so we will be doing a lot of these in the very near future so I appreciate your fast responses.

    Remember to let me know when you come to Bar Harbor so I can buy you lunch or dinner

Page 1 of 2 12 LastLast

Similar Threads

  1. Infusions/Injections
    By sweepitup in forum Emergency Department
    Replies: 2
    Last Post: 10-20-2013, 12:20 AM
  2. Injections and infusions
    By adahl@fast-air.net in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-11-2011, 08:35 PM
  3. Injections and infusions
    By Shawna Paul in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-15-2010, 07:35 AM
  4. Infusions/injections
    By 01096327 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 10-16-2009, 11:16 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.