Drug administration charge capture is an important aspect to review when it comes to infusion services, considering that drug administration is a significant component of many patients’ treatment and care. Coding an observation encounter (including when a patient may have arrived through the Emergency Department [ED] and been placed in observation status) can have a variety of confusing elements for some charge capture and coding staff. Let’s review some of the fundamentals to encourage success throughout 2022 and beyond.
Guidance Knowledge and Tips for Success
As many know, the date of service must be considered in which the drug administration occurred, but also it must be understood that you are treating a multiple-day outpatient stay as one encounter. What does this mean? In other words, you apply the drug administration coding hierarchy to the entire stay regardless of the number of days. Staff will need to keep the following in mind:
- Understand that only one initial service (e.g., 96360, 96374, 96365) can be reported for the entire observation encounter. Establish which drug will be coded as initial so you can easily select the subsequent service codes (e.g., 96361, 96375, 96376, 96368).
- Multiple intravenous administrations of the same drug on the same date of service requires adding the times together for each bag hung so that the units for “each additional hour” are not overstated. Note that you must first determine if the individual administrations will be billed as a “short infusion” lasting 15 minutes or less as this administration would be reported as IV push rather than therapeutic drug infusion. One example is IV Rocephin. This drug is often packaged in an IV bag and intended to be infused over 15 minutes or less. In this case, an IV push code would be reported because the drug was infused over a short period of time—less than 15 minutes.
- What should you do when no stop time is present? Follow your hospital’s own internal policy for coding IV infusion versus IV push when no stop time is present. Most payers including Medicare Administrative Contractors (MACs) will permit reporting of an IV push code when a stop time is not present for the therapeutic drug infusion.
- Multiple IV pushes of the same drug are coded for each administration for the entire observation encounter. Each date of service does not restart use of code 96374 or 96375. Code 96376 can be reported for each IV push of the same substance/drug if a minimum of 31 minutes has elapsed between administrations of the same drug. This 31-minute lapse in time is not a requirement for administration of the drug itself—only for determining how many billed units can be reported for CPT 96376.
- Finally, remember if no stop time for IV hydration is documented then this cannot be coded as 96360 or 96361.
These are not all the tips and knowledge necessary for successfully mastering this service. Overcome more everyday challenges and find further educational insights by utilizing our 2022 Coding Essentials for Infusion & Injection Therapy Services.
