Don't let the coding of injections and infusions cause CONFUSION! In this webinar, you will learn how to eliminate any confusion related to the proper coding of injections and infusions. You will also learn about new CPT codes for 2017, key definitions and documentation principles, and proper infusion times. By the end of this webinar participants will be able to: Become proficient on proper code selections pertinent to pediatric vaccinations and administration Ensure proper payment for drug claims and drug administration submit to Medicare Determine tips and tricks for proper code selection related to drug administration, infusions and injections Learn the different codes created by the American Medical Association (AMA) for “initial” and subsequent administrations

1. Avoid Confusion on Infusions!
Infusion and Injection Coding
Tips and Tricks
PresentedBy:
NikkiTaylor, MBA,COC, CPC, CPMA, AAPC Fellow
LeadAuditor, TheCodingInstitute
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2. Learning Objectives
• Basic overview and history of infusion therapy
• Master hydration, infusion, injection and
pediatric vaccine coding
• Nail down billing hierarchy
• Power up your knowledge of HCPCS and
modifiers
• Get to know documentation pitfalls and
recommendations
• Highlight helpful resources and tools
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3. Progression of InfusionTherapy
• First researched and attempted in 1600s
• Significant advancement in 20th and 21st century
• 1920’s Dextrose was 1st used as an infusate
• 1930’s Slow drip method of transfusion
• 1940’s
• Disposable admin sets developed
• Flexible IV catheter introduced
• 1960 Peripherally inserted cath lines introduced
• 1970 CDC developed IV therapy guidelines
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4. Progression of InfusionTherapy
• 1980’s
• Implantable ports
• Home blood transfusion
• Osteoport developed
• Pain controlled analgesia increased
• National Standards of Infusion Practice issued by NITA
• First credentialing exam for nurses offered by NITA
• NITA changed to Intravenous Nurses Society (INS)
• Many more improvements and developments since…
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5. Back to the Basics
•Two main routes of administration for IV
drug administration services:
•Injection
•Infusion
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6. Back to the Basics
• Injections
• Drugs delivered in one shot
• Quickly or over a period of time
• Immediate effect
• Subcutaneously-under the skin
• Intramuscularly-deep into the muscle
• Intra-arterially –directly into an artery or arteries
• Intravenously-directly into a vein
• Piggyback-existing IV tube inserted into a vein
• IV Push
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7. Back to the Basics
•Infusions:
• Administration of IV fluids or drugs
• Saline or other solutions
• Over a period of time
• Therapeutic or diagnostic
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8. Back to the Basics
• Three main categories of drugs and medication:
• Chemotherapy
• Treats cancer
• Non-chemotherapy
• Therapeutic
• Prophylactic
• Diagnostic
• Hydration
• Electrolytes
• Hanging bag with fluids
• Sugar and carbohydrates for energy
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9. Billing Basics
•Hierarchy
•Pay Attention to CPT guidelines and
instructions
•Payer Policies
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10. What Does CPT Say?
•Hierarchy
• Applies to facility not clinic setting
• “Chemotherapy services are primary to therapeutic,
prophylactic, and diagnostic services which are
primary to hydration services. Infusions are
primary to pushes which are primary to injections.”
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11. What Does CPT Say?
• Hierarchy
• IV pushes are subject to the hierarchy
• Subcutaneousand intramuscular injections are not
• Do not contain “initial” in their descriptors
• Are not IV services
• Overrides parentheticalinstructions for add-on codes
• Use parenthetical notes in conjunction with the hierarchy
• Hierarchy takes precedence
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12. Chemotherapy IV Infusion
Chemotherapy IV Push
Chemotherapy Injection(IM/SQ)
Non-Chemotherapy IV Infusions
Non-Chemotherapy IV Push
Non-Chemotherapy Injections
Hydration IV Infusion
Hierarchy
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13. Drug Administration Services
• Three categories:
• Hydration
• 96360-96361
• Therapeutic, prophylactic, diagnostic (Injections and Infusions)
• 96365-96379
• Chemotherapy, High complex drug or biologic agent
• 96401-96549
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14. Drug Administration Services
• Initial, sequential, and concurrent services
• Add-on Codes
• Pay attention to the descriptors
• Remember IV injection and infusion admin codes are subject to
hierarchy in the facility setting and NOT in office setting
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15. Initial Services
• Professional Services:
• Primary reason for the encounter
• Regardless of the sequential order in which the injections or infusions are administered
• Facility:
• Based on hierarchy
• Use only 1 initial service code
• Unless the protocol or patient condition requires two separate IV
lines to be utilized
• The difference in time and effort would be reported using the initial
service code with modifier -59 added
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16. Sequential Services
• IV push or infusion of a new substance or drug following the primary
or initial service
• All sequential services require a new substance or drug
• Facilities may report a sequential intravenous push of the same drug
using 96376; Therapeutic, prophylactic, or diagnostic injection (specify
substance or drug); each additional sequential intravenous push of
the same substance/drug provided in a facility (List separately in
addition to code for primary procedure)
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17. Concurrent Services
• Infusion of a new drug or substanceinfused at the same time as another
substanceor drug
• Not time based
• Can only be reported once per day
• Regardless of whether an additional new drug or substance is administered concurrently
• Hydration may not be reported with any other service
• A separate subsequent concurrentadministration of another new drug or
substance(3rd substance)is not reported
• Multiple infusions of the same drug or substanceon the same DOS, the initial
code should be reported
• The 2nd or subsequent infusion(s) should be reported based on the individual
time of each additional infusion of the same drug or substanceusing the
appropriate add on code.
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18. Important Questions to Ask
• Chemotherapy
• Non-Chemotherapy
• Injection
• Infusion
• IV Push
What did the
patient receive?
• IV Infusion
• IV Injection
• SubQ
• Intramuscular
• Combination
Method?
• < 15 minutes
• > 15 minutes
• First hour
• Each additionalhour
Time?
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