CODING CORNER: Give Your Infusion Coding a Boost with these Regulation Updates

Tip: List only one initial infusion in most cases


The 2007 OPPS final rule included some major changes to drug administration coding. Now, most of the HCPCS codes once used to report injections and infusions are retired, and the way reimbursement for these services is  calculated has changed as well. Is your drug administration coding up-to-date?

Drop These C Codes

The Centers for Medicare & Medicaid Services has adopted the full set of CPT codes for drug administration under OPPS and retired six HCPCS codes that were being used to report injections, infusions and chemotherapy treatments. The discontinued codes are C8950, C8951, C8952, C8953, C8954 and C8955.

Take note: HCPCS code C8957 (Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion [more than 8 hours], requiring the use of portable or implantable pump) remains because no current CPT code covers this service.

The change from HCPCS to CPT is appropriate, says Terry Byrne, CPC, of Terry Byrne, CPC Inc., in Brunswick, Ga. HCPCS Level II codes are intended to be temporary codes, yet therapeutic/diagnostic infusions and chemotherapy services have been assigned to HCPCS codes for many years. The change to CPT codes also allows providers to bill for and be reimbursed for hydration infusions, she says.

These drug administration code changes for the hospital outpatient department are intended to bring reporting in line with those codes used in the freestanding center/office site of service, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders’ National Advisory Board. This will enable CMS to effectively compare the services performed and also to standardize reimbursement for each sequential drug and/or additional hour of administration, she says.

Note This Reimbursement Change

CMS has also decided to change the policy that bundled additional hours of infusion into the first hour. Now you’ll receive reimbursement for additional hours of infusion.

Hospitals have always been instructed to report the codes for “each additional hour” -- this is just the first year that they will be paid based on this reporting mechanism, Parman says. You can report all of the additional hours of infusion time, if they meet the CPT definition of “greater than 30 minutes” into each subsequent hour, she says.

CMS has also changed the  descriptors for +90761 (Intraven-ous infusion, hydration; each additional hour), +90766 (Intra-venous infusion, for therapy, prophylaxis, or diagnosis … each additional hour), and +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour) to remove the statement that they were to be billed for each hour “up to 8 hours” or “1 to 8 hours.”

This change was made primarily for hospital charging, Parman says. While CMS does not expect freestanding centers/offices [...]

- Published on 2007-03-01