Correctly coding for injections and infusions can often feel like a shot in the dark. From assigning codes for multiple drugs to add-on codes to accurately documenting stop and start times, even the most experienced coders feel the pinch of these complex coding guidelines.

But code claims incorrectly, and you could be costing your practice thousands of dollars in drug costs and lost revenue.

To code claims optimally for injections and infusions, you must not only master the often confusing definitions of multiple terms and know coding guidelines inside and out, but you must also be adept at choosing the best code for your claim from among many options.

To Choose Initial Infusion Code, Ask Four Simple Questions

Unless your patient has multiple IV access sites or you’re dealing with multiple encounters on the same date of service, you’ll most often be choosing only one initial service code — even when multiple drugs are involved. When choosing the most appropriate code, ask yourself four questions:

• Why is the patient here (purpose of visit/type of treatment)? If the patient is seen in a physician office, choose the initial code based on the primary reason for the visit. But in an outpatient facility, you’d choose the initial code based on a hierarchy. Chemotherapy outranks all other services. Infusions are next, followed by injections, and finally, hydration.
• How was/were it/they administered? This includes not only the type of administration (i.e. infusion, IV push, subcutaneous or intramuscular injection, etc.), but also the order. For example, when one drug is provided concurrently to another (at the same times), you’d use add-on code 96368).
• How long did the service take? Recording start and stop times are essential for garnering ultimate reimbursement. For example, if a patient received an infusion lasting between 16 minutes and one hour, you’d use code 96365 (Initial infusion of up to one hour). But if the infusion lasted less than 16 minutes, you’d choose code 96374 (Initial push or infusion less than 16 minutes).

Important: If the documentation does indicate a separate site or separate encounter, you may need to choose more than one initial service code and append modifier 59 to one of those codes. For example, if a patient received an intramuscular injection along with an infusion, you’d use code the injection using 96372 (Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular) and append modifier 59.

Be Diligent About Coding for Discarded Drugs

Beginning Jan. 1, 2017, CMS has allowed providers to code for the amount of drug discarded (drug wastage) from single-dose or single-use vials, and get paid for the discarded amount. However, many providers are still not documenting drug wastage correctly — or at all.

That means lost revenue, or in the case of incorrect coding, running afoul of auditors and regulators. To properly code and get reimbursed for discarded drugs, you should code the number of drug units administered to the patient on one line of the claim.

Then, indicate the number of units discarded on the following line, appending the modifier JW. Those two amounts should add up to the amount listed on the drug label, and you also must document the amount of wastage in the patient record.

Watch Out: You may not use modifier JW when the billing unit of a drug is equal to or greater than the dose administered and discarded. For example, say a billing unit for a drug is 20 mg. You administered 15 mg and discarded 5 mg. You would only bill one 20 mg unit. If you billed the 5 mg of wastage, the total billed would be 25 units, and that would constitute overpayment.

Accurately Record Infusion Start and Stop Times

Most providers are diligent about documenting start times, but unfortunately fail to do the same for stop times. That means losing out on reimbursement. For example, if you’ve only recorded the start time for an infusion, you must treat it as if it lasted 15 minutes or less (96374), no matter the actual duration of the service.

Recording start and stop times is also important when coding concurrent or sequential infusions (those that occur at the same time or after the initial service). You must know the chronological order of the infusions to choose the correct codes.

Example: A patient receives a certain drug via IV push (IVP) and at the same time is receiving hydration. To code for hydration time, you may only count the amount of time that the hydration occurred alone. If the IVP ran concurrently for the entire length of hydration time, you may not code separately for the hydration. Alternatively, if the hydration ran for one hour and the IVP ran concurrently for 30 minutes, you may code for 30 minutes of hydration time.

Take Online Training for Coding injection and Infusion Services

Between the required code hierarchy, the multitude of interchangeable add-on codes, and drugs being injected and infused along with the units administered, it’s surprising anything gets paid. Not to mention the fact that infusion codes have multiple meanings, which can make getting paid accurately and optimally almost impossible.

With a few proven techniques from national coding expert, Lynn Anderanin, CPC, CPMA, CPC-I, CPPM, COSC, you can reduce denials and get paid more for your injection and infusion claims.

During an online training session, Lynn will walk you through how to file more accurate injection and infusion claims, and ultimately collect more of the reimbursement you deserve.

This online training will help you pin down injection and infusion required documentation, successfully account for drug payments, and uncover additional reimbursement opportunities for these every-day services.

---

Training Webinars Selected For You