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ED Coding and Reimbursement Alert

4 Rules to Remember:

Infusion Coding Do's and Don'ts

Published on Fri May 07, 2004

Remember: Chemo has its own set of codes

When reporting infusion codes, make sure you keep these tips in mind and increase your chances of maximum reimbursement:

  • Do report injections into the intravenous (IV) line independently with 90784; they aren't part of the infusion package.

  • Do keep the "T" discount in mind when reporting to Medicare. Code Q0081 is subject to the "T" status discount, Marsh says, so when you have another "T" code on the claim, reimbursement for the less-expensive code will be 50 percent.

    If a patient needs IV treatment and intermediate repair of a 4.2-centimeter scalp laceration, for example, you would receive 100 percent payment for 12032 (Layer closure of wounds of scalp, axillae, trunk, and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm) and 50 percent for Q0081.

  • Don't use any of the above infusion codes for chemotherapy sessions; report chemo with the 96400-96549 code set.

  • Don't let your claim hit the mailbox until you're certain that your documentation confirms the physician's presence during the session; it is required when using infusion codes.

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