This page addresses follow-up questions and additional information pertinent to our webinar
Investigating Injections & Infusions.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: A patient was seen for low potassium level. He received 1 hour of intravenous hydration fluid mixed with potassium for treatment of the patient's low potassium level. What would the correct CPT code be for this encounter?
A: Report CPT code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, for the intravenous infusion of potassium. It would be inappropriate to report the hydration code for this encounter because the infusion was provided primarily for treatment of the patient's low potassium level.
Q: For hydration to be considered medically necessary, is there a minimum flow rate and/or a specific volume that must be infused?
A: Some payers may have specific guidelines for these. One Medicare Administrative Contractor indicates providers should not bill hydration if the total volume infused is less than 500cc. Be sure to check with your payers!
Q: Can more than one concurrent infusion be reported per encounter?
A: No. Per CPT Coding Handbook; A concurrent infusion service is not time based and is only reported once per day regardless of whether an additional new drug or substance is administered concurrently. Hydration may not be reported concurrently with any other service. A separate subsequent concurrent administration of another new drug or substance (the third substance or drug) is not reported.
Q: How would you report 96360 and 96361 x1 or 96360 and 96361 x2 for this scenario:
- 1 bag ran for 60 minutes 10/6/22 1000-1100
- 2nd bag ran for 31 minutes 10/6/22 1300-1331
- 3rd bag ran for 31 minutes 10/6/22 1500-1531
In this scenario, a total of 2 hours and 2 minutes of hydration were provided in three separate nonconsecutive increments.
A: Report 96360 x1 and 96361 x2.
Per CPT Assistant December 2011, Volume 21, Issue 12, page 3 (Coding Clarification: Facility Reporting—Multiple Infusions (Codes 96360, 96361, 96365-96367), "It is important to remember that for both physician and facility reporting, when multiple injections or infusions are individually prepared, these services are recognized and reported as individual administrations. Therefore, it is not appropriate to base code choice on a summation of the total time of all administrations performed."
Q: How would the below scenario be reported with 96360 and 96361 x3 or do the times get added together to be reported with codes 96360 and 96361 x4?
- NS started 10/30/22 @ 1510-1720 (2h 10m)
- 2nd bag of NS started 10/30/22 @ 1735-1957 (2h 22m)
In this scenario, a total of 4 hours and 32 minutes of hydration was performed but they were not consecutive.
A: Report 96360 x1 and 96361 x3.
Per CPT Assistant December 2011, Volume 21, Issue 12, page 3 (Coding Clarification: Facility Reporting—Multiple Infusions (Codes 96360, 96361, 96365-96367), "It is important to remember that for both physician and facility reporting, when multiple injections or infusions are individually prepared, these services are recognized and reported as individual administrations. Therefore, it is not appropriate to base code choice on a summation of the total time of all administrations performed."
Heather Bertolami, CCS
Senior Coding Quality Auditor
Heather brings over 20 years of experience to the Haugen team, specializing in a variety of HIM and coding roles. She started her career as a coder and quickly moved into management positions, eventually becoming an auditor. Now auditing for 8 years, Heather specializes in inpatient coding with a focus on DRGs. She enjoys digging into our client data to help them find areas of opportunity, providing them with the necessary information, guidelines and best practices to improve their skills. Heather’s humorous personality provides our clients with an easygoing environment to enhance their coding skills with confidence.
Terri Reid, CCS, CCS-P, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer
Senior Coding Quality Auditor
Terri comes to Haugen group with 25+ years of health information management experience in coding, auditing and education. She spent a number of years volunteering as an EMT and working in an Emergency Department before she transitioned into a career coding ED records. It wasn’t long before she was trained to code SDS and IP records eventually using her clinical background to help pioneer a concurrent query program at a level I trauma facility in the northeast. With the implementation of ICD-10, she helped develop coding protocols as well as provide education to physicians on the impact of their documentation.
If a patient has two IV sites (obviously having two primary codes), does the hierarchy continue for each separate line? Example:
Line One: Rocephin 60 min (96365), Zofran push (96375) @9am
Line Two: Zithromax 60 min (96365/59), Zofran push @10 am (??)
Would the Zofran in line 2 be reported as 96375 since it’s a “new substance” in that line? Or would it be 96376 since that “same” drug was given earlier in Line 1?
Hi Jocelyn, Great question. We recommend you submit this question to Coding Clinic HCPCS clarification.
Apologies, I didn’t see this. Appreciate the response and will definitely do this.
If possible, one other question that has arisen regarding DOS on overnight visits.
On slide 14, for the answer on hydration, you calculated:
96361 x 2 (2/22)
96361 x 1 (2/23)
This is how I also would have charged this. I’ve always looked at each hour (unit) separately and have attributed that unit to the DOS that it started.
However, I had an auditor who took the following from CPT (in the section of explanation before hydration starts) to argue that all three of those units should be reported on 2/22: “For continuous services that last beyond midnight, use the date in which the service began and report the total units of time provided continuously.”
She is defining “continuous” as the entire service until the bag stops and reporting all units on that start date. I feel the intention is that they are preventing a facility from starting a service over at midnight. For example if a drug infused from 1140 pm until 1240 pm, they are clarifying that you can’t code the infusion 1140-1200 as an infusion, and then from 1200-1240 as another infusion.
But I honestly can’t find anything concrete anywhere answering the question. Do you have an opinion on this?
Hi Jocelyn,
Per Medicare Claims Processing Manual 100-04, Chapter 4, section 230.2B (Billing for Injections and Infusions): Drug administration services are to be reported with a line item date of service on the day they are provided. In addition, only one initial drug administration service is to be reported per vascular access site per encounter, including during an encounter where observation services span more than 1 calendar day.
Hopefully, this helps!
Thank you very much. This was what I had been using as well.
If a patient comes in the morning for an infusion of antibiotics and anti-nausea push and then returns in the evening for the exact same service, how are the evening services billed?
Hi Emily,
In addition to checking with your payer, please see Coding Clinic for HCPCS (4Q 2004 page 6: CMS changing from Q codes to CPT codes or drug administration):
Multiple visits for administration-same day The November 2004 final rule instructs hospitals to use modifier 59 (distinct procedure) when billing charges for drug administration services furnished during multiple visits that follow the initial visit on the same day. For example, a patient may have two visits to the hospital for antibiotic administration on the same day.
The hospital should assign code 90780 with modifier 59 for each separate visit for infusion. With modifier 59 appended to CPT codes 90780 and 90781, the OCE will allow up to four units of APC 0120 (infusion of nonchemotherapy drugs) to be paid.
If modifier 59 is not reported, the OCE will collapse all codes that map to a particular APC into one unit of that APC and will only pay one unit of each applicable APC.
Note that 90780 and 90781 were deleted in 2009. Instead, you’ll need to use the appropriate injection and infusion code from the current code list.
If you are looking for additional education on this topic, please check out our online course series, Coding for Injections and Infusions: https://www.thehaugengroup.com/marketplace/online-course/cpt/cpt-injection-and-infusion-series/
Would a -76 be appropriate in a situation like this?
Hi Emily,
Yes, modifier 76 could be applicable. The below article from Novitas discusses modifier 76 and the article from Noridian specifically states 76 may be used with injections.
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00092327
https://med.noridianmedicare.com/web/jfb/topics/modifiers/76