# Auditor states drug ordered as IV over 2 minutes must have a doc stop time?



## chris235 (Jan 21, 2019)

Hello everyone,

We are currently experiencing a situation in which an auditor is stating that all IV drugs ordered by the physician with an expected duration of 1-2 minutes must have a documented stop time in order to charge the 96374, 96375 or 96376.

I have never encountered a situation like this in over 5 years.  Perhaps I've missed verbiage in the CPT coding book that states it must be present?

Any help would be appreciated.


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## purplescarf23 (Jan 29, 2019)

When its just an IV PUSH there does not need to be a stop time.  If it truly was an IV drug hung for say 20  minutes yes there would need to be start and stop times but the PUSH IV drugs do not need the stop time.  Here's a snipped from the encoder we use.  




Physician or other qualified health care professional work related to hydration, injection, and infusion services predominantly involves affirmation of treatment plan and direct supervision of staff.

Codes 96360-96379, 96401, 96402, 96409-96425, 96521-96523 are not intended to be reported by the physician in the facility setting. If a significant, separately identifiable office or other outpatient Evaluation and Management service is performed, the appropriate E/M service (99201-99215, 99241-99245, 99354-99355) should be reported using modifier 25 in addition to 96360-96549. For same day E/M service, a different diagnosis is not required.

If performed to facilitate the infusion or injection, the following services are included and are not reported separately:

a. Use of local anesthesia

b. IV start

c. Access to indwelling IV, subcutaneous catheter or port

d. Flush at conclusion of infusion

e. Standard tubing, syringes, and supplies

    (For declotting a catheter or port, use 36593)

When multiple drugs are administered, report the service(s) and the specific materials or drugs for each.

When administering multiple infusions, injections or combinations, only one ''initial'' service code should be reported for a given date, unless protocol requires that two separate IV sites must be used. Do not report a second initial service on the same date due to an intravenous line requiring a re-start, an IV rate not being able to be reached without two lines, or for accessing a port of a multi-lumen catheter. If an injection or infusion is of a subsequent or concurrent nature, even if it is the first such service within that group of services, then a subsequent or concurrent code from the appropriate section should be reported (eg, the first IV push given subsequent to an initial one-hour infusion is reported using a subsequent IV push code).

Initial infusion: For physician or other qualified health care professional reporting, an initial infusion is the key or primary reason for the encounter reported irrespective of the temporal order in which the infusion(s) or injection(s) are administered. For facility reporting, an initial infusion is based using the hierarchy. For both physician or other qualified health care professional and facility reporting, only one initial service code (eg, 96365) should be reported unless the protocol or patient condition requires that two separate IV sites must be utilized. The difference in time and effort in providing this second IV site access is also reported using the initial service code with modifier 59 appended (eg, 96365, 96365-59).

Sequential infusion: A sequential infusion is an infusion or IV push of a new substance or drug following a primary or initial service. All sequential services require that there be a new substance or drug, except that facilities may report a sequential intravenous push of the same drug using 96376.

Concurrent infusion: A concurrent infusion is an infusion of a new substance or drug infused at the same time as another substance or drug. 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.

In order to determine which service should be reported as the initial service when there is more than one type of service, hierarchies have been created. These vary by whether the physician or other qualified health care professional or a facility is reporting. The order of selection for reporting is based upon the physician's or other qualified health care professional's knowledge of the clinical condition(s) and treatment(s). The hierarchy that facilities are to use is based upon a structural algorithm. When these codes are reported by the physician or other qualified health care professional, the ''initial'' code that best describes the key or primary reason for the encounter should always be reported irrespective of the order in which the infusions or injections occur.

When these codes are reported by the facility, the following instructions apply. The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy is to be followed by facilities and supersedes parenthetical instructions for add-on codes that suggest an add-on of a higher hierarchical position may be reported in conjunction with a base code of a lower position. (For example, the hierarchy would not permit reporting 96376 with 96360, as 96376 is a higher order code. IV push is primary to hydration.)

When reporting multiple infusions of the same drug/substance on the same date of service, the initial code should be selected. The second and subsequent infusion(s) should be reported based on the individual time(s) of each additional infusion(s) of the same drug/substance using the appropriate add-on code.

Example: In the outpatient observation setting, a patient receives one-hour intravenous infusions of the same antibiotic every 8 hours on the same date of service through the same IV access. The hierarchy for facility reporting permits the reporting of code 96365 for the first one-hour dose administered. Add-on 96366 would be reported twice (once for the second and third one-hour infusions of the same drug).

When reporting codes for which infusion time is a factor, use the actual time over which the infusion is administered. Intravenous or intra-arterial push is defined as: (a) an injection in which the individual who administers the drug/substance is continuously present to administer the injection and observe the patient, or (b) an infusion of 15 minutes or less. If intravenous hydration (96360, 96361) is given from 11 PM to 2 AM, 96360 would be reported once and 96361 twice. For continuous services that last beyond midnight, use the date in which the service began and report the total units of time provided continuously. However, if instead of a continuous infusion, a medication was given by intravenous push at 10 PM and 2 AM, as the service was not continuous, the two administrations would be reported as an initial service (96374) and sequential (96376) as: (1) no other infusion services were performed; and (2) the push of the same drug was performed more than 30 minutes beyond the initial administration. A ''keep open'' infusion of any type is not separately reported.


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## arbucklej (Aug 26, 2020)

Above states:   _ For both physician or other qualified health care professional and facility reporting, only one initial service code (eg, 96365) should be reported unless the protocol or patient condition requires that two separate IV sites must be utilized. The difference in time and effort in providing this second IV site access is also reported using the initial service code with modifier 59 appended (eg, 96365, 96365-59)._

So this means two initial services can be billed on the same day?


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