Coding infusions is far from run-of-the-mill, and if you don’t get it right, you’ll likely see reduced — if not denied — claims. One of the key concepts when reporting this service is understanding the type of infusion you’re providing. Get it right, and your claim sails through, but get it wrong, and you’ll be chasing the payments you deserve.
There are four types of infusion administrations that affect your code choice:
- Initial— This is the key or primary reason the patient is receiving infusion, regardless of the order in which she receives medications. For instance, if the patient receives 1 hour of pre-chemotherapy medication (such as an antiemetic, antibiotic, etc.) before 3 hours of chemotherapy infusion, you would report the chemotherapy as the initial infusion because that is the reason the patient is present for therapy.
In addition, you can report only one “initial” service code per patient visit, unless the patient requires two separate IV access sites. If that’s the case, then you would report two initial services codes with modifier 59 (Distinct procedural service) attached to the second code (for example, 96413 and 96413-59). In most cases, however, you’ll likely only have one initial service.