The ABCs of infusions and injections: What you need to know about coding for drug admin in 2021
by Jeremy Gilman
Drug administration coding can be quite challenging. It’s pretty normal to question if you’re coding correctly, as even experienced coders struggle with it
As part of our ongoing webinar series, our resident Codemistress, Bobbi Buell, recently led a fascinating and informative live webinar, “The ABCs of Infusions and Injections.” The event was attended by over 800 medical practice managers and life sciences experts. It was an hour of practical training and expert insight for professionals involved with infusions and injections.
Here are 8 key takeaways from the webinar:
The CPT codes for hydration are 96360–96361. The CPT codes for therapeutic, prophylactic, and diagnostic injections and infusions are 96365–96379. And the CPT codes for chemotherapy and other highly complex drug, or highly complex biologic agent administration are 96401–96549
practices are not subject to the CPT coding hierarchy, as it’s only applicable to facilities like hospitals.
In the office setting, initial infusion should be selected according to the primary reason for the patient-doctor encounter. This is not affected by the order in which the infusions or injections given were actually administered. You can only select one initial code per session of therapy.
A sequential infusion is the infusion of a new drug or substance before or after the initial service. It must be a separate bag of a drug or agent. You could report more than one sequential infusion code if you administered multiple, separate drugs. To code for a sequential infusion, you must have first reported an initial infusion.
Each additional hour codes are for additional hours of an initial infusion or additional hours of an infusion of a sequential/subsequent infusion. This means they can be added on to either an initial infusion or a sequential infusion as long as time parameters are met in terms of rounding up past 30 minutes.
A concurrent infusion happens when a new substance or drug is infused at the same time as another substance or drug. Concurrent infusions are not time-based, and are only reported once per day, regardless of whether there was more than one additional new drug administered concurrently. You cannot report hydration services concurrently with any other administration service. There is also no code for concurrent chemotherapy infusions. Instead, they are reported under the unlisted chemotherapy administration code--but this is rare.
Incident to’ a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness. For the supplies and services ‘incident to’ the professional services to be covered, there must be direct physician supervision of the auxiliary personnel rendering the service.
Direct supervision, in ‘incident to’ service administration, in the office setting does not mean that the physician must be present in the same room with the auxiliary personnel. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the services are being performed.
Extra Tip: To code more accurately for drug administration services, you should ask yourself the following questions: Why was the patient in the office? What did we give them? How was it administered? And how long did it take? These questions will help you capture the information you need to choose the correct codes.
Disclaimer: The information in the article is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional, coding, or legal advice. Additionally, laws and regulations and insurance and payor policies are subject to change. Information that has been accurate previously can be particularly dependent on time or circumstances.
Jeremy Gilman
Jeremy is a co-founder and the chief marketing officer of RxVantage. His teams are focused on growing the RxVantage network of medical practices and improving the customer and product experience to increase engagement and accelerate revenue. Jeremy has partnered with leaders at dozens of companies to help them develop and execute growth, product and digital transformation strategies that increased valuations and led to liquidity events. He is a frequent speaker on digital transformation, mobile and customer centricity. jeremy@rxvantage.com
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