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help w/chart note regarding office infusions

  1. #1
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    Everett, WA
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    Default help w/chart note regarding office infusions
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    I'm stalled again, respected colleagues! When will I ever understand the correct application of the infusion codes?

    Established pt. is in to see the neurologist for ongoing persistent HA. He is seen by the doctor but returns later in the afternoon w/HA and requesting IV medication

    ...." An IV was started at 2:45 PM and 100 mL of saline was infused over 30 minutes. IV infusion ended at 3:15 PM.

    Another IV bag containing 100 mL of normal saline and 3 mg of Dilaudid was infused over 30 minutes. IV infusion started at 3:20 PM and ended at 3:50 PM. The IV gradually infiltrated and another side was chosen. Another IV was started and 3 mg of IV Dilaudid was added to 100 mL of normal saline and infused over 30 minutes. IV infusion started at 4 PM and then at 4:30 PM. Patient was monitored for 30 additional minutes..."

    Hydration: I cannot report the 96360 because it is 30 minutes or less, correct? Can I report the 96361 because of the parenthetical notes at the end of the notes: (Report 96361 to identify hydration if provided as a secondary or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access) Does this qualify as secondary?
    96365
    +96367
    I see subsequent but no concurrent infusions, so these are the choice of codes.

    These issues make me long for a reference source entitled "Infusion for Dummies". Don't work the facility side, so really this shouldn't be so hard to grasp, right?

    Thanks people!

    Suzanne E. Byrum, CPC

  2. #2
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    Quote Originally Posted by ollielooya View Post
    I'm stalled again, respected colleagues! When will I ever understand the correct application of the infusion codes?

    Established pt. is in to see the neurologist for ongoing persistent HA. He is seen by the doctor but returns later in the afternoon w/HA and requesting IV medication

    ...." An IV was started at 2:45 PM and 100 mL of saline was infused over 30 minutes. IV infusion ended at 3:15 PM.

    Another IV bag containing 100 mL of normal saline and 3 mg of Dilaudid was infused over 30 minutes. IV infusion started at 3:20 PM and ended at 3:50 PM. The IV gradually infiltrated and another side was chosen. Another IV was started and 3 mg of IV Dilaudid was added to 100 mL of normal saline and infused over 30 minutes. IV infusion started at 4 PM and then at 4:30 PM. Patient was monitored for 30 additional minutes..."

    Hydration: I cannot report the 96360 because it is 30 minutes or less, correct? Can I report the 96361 because of the parenthetical notes at the end of the notes: (Report 96361 to identify hydration if provided as a secondary or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access) Does this qualify as secondary?
    96365
    +96367
    I see subsequent but no concurrent infusions, so these are the choice of codes.

    These issues make me long for a reference source entitled "Infusion for Dummies". Don't work the facility side, so really this shouldn't be so hard to grasp, right?

    Thanks people!

    Suzanne E. Byrum, CPC
    IV codes are the bane of my existence, as well. You mentioned "another side was chosen" - does that not mean that a separate access was created? (That's how I would have read it, so I need to see if I'm wrong...)

  3. Default
    Hello!! The code will not be concurrent nor subsequent (sequential). The reason it is not sequential is because Dilaudid is the only medication that was given. Nor will the code be concurrent - this is only used when you have 2 med infusions running same time/same site. What you do is add the 30 min increments of NS/Dilaudid and if the total amount of time equals <91 mins then your code is 96365. If the NS that started at 2:45 and ended at 3:15 had run for 31 mins (it did not) then that would have been the only hydration hr (96361) that you would have been able to capture. Hope this helps

  4. #4
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    Everett, WA
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    Again, I'm still puzzled. Thanks for trying to help me understand! Aside from the poor documentation (am planning on sending back for clarification), the comment at the end of add on code 96367 : "Report 96367 only once per sequential infusion of[I] same infusate mix[/I---] Wouldn't this qualify it as a
    additional sequential infusion even if (for sake of discussion) latitude was extended for the allowable time? So additional sequential infusion = different drug? Perhaps I'm tripping over the "different initial service is administered thru the same IV access? This wasn't the case here as "another side" and "another IV". I'm trying to make sense and UNDERSTAND the guidelines.
    So again, after reconsidering it is wrong to code the 96360 (IF it were 31 minutes or greater), AND the 96365 (if it were over 60 minutes)? Guess others are confused as I am on this topic. ---Suzanne

  5. Default
    CPT Assistant: Bonus Feature: Special Q & A

    CPT Assistant December 2009, Volume 19, Issue 12, page 14



    Intravenous Infusions



    Medicine: Hydration, Therapeutic Infusion Services



    Question: For facility reporting, three infusions of the same drug are administered having the following start- and stop-times: 11:00 am-12:13 pm; 12:15 pm-1:00 pm, 1:01 pm-1:15 pm. When choosing the appropriate codes, should the total infusion time be considered or do these represent three separate infusion services?

    Ann Waters, RHIT, CCS



    Answer: For both physician and reporting purposes, when multiple administrations are individually prepared, these services are recognized and reported as individual administrations. In this circumstance, code choice is not based on the total time of all administrations performed, but rather on the timeframe of each separate administration service and whether the same or different drug(s) is/are involved.



    Therefore, two of the three doses of the same drug would be reported using code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, for the first intravenous infusion from 11:00 am -12:13 pm.



    Code 96367, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure), would be reported for the 12:15 pm-1:00 pm dose.



    Since the third infusion from 1:01 pm-1:15 pm is less than the 30-minute reporting requirement, add-on code 96366, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) would not be additionally reported.

  6. #6
    Location
    Everett, WA
    Posts
    886
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    SO, based on the answers and documentation above, it appears there is diversity of opinion (as always). Please bear with me as I press on to seek enlightenment. Will repeat part of the scenario to focus on the thread:

    "........" An IV was started at 2:45 PM and 100 mL of saline was infused over 30 minutes. IV infusion ended at 3:15 PM. (was it over 30 minutes or not?)

    Another IV bag containing 100 mL of normal saline and 3 mg of Dilaudid was infused over 30 minutes. IV infusion started at 3:20 PM and ended at 3:50 PM. (was it over 30 minutes or not?) The IV gradually infiltrated and another side was chosen. Another IV was started and 3 mg of IV Dilaudid was added to 100 mL of normal saline and infused over 30 minutes. IV infusion started at 4 PM and then at 4:30 PM. (again, was it over 30 minutes or not?) Patient was monitored for 30 additional minutes..."

    Hydration: I cannot report the 96360 because it is 30 minutes or less, correct? Can I report the 96361 because of the parenthetical notes at the end of the notes: (Report 96361 to identify hydration if provided as a secondary or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access) Does this qualify as secondary?

    IF the timelines were met could it be coded as:
    96360 ?
    96365?
    +96367 AND if the timeframes were met, 96366 might be an additional code, too?
    Based upon the most recent submission of Coding Assistant Guidelines as shared above (THANK YOU!), it appears these codes might be correct, or am I not understanding once again?

    As usual, relying on the patience of the coding community to lead to "higher ground!" It would be so helpful to have had some clinical background in my past. Unfortunately, this is not the case.

    ---Suzanne

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