Internal Medicine Coding Alert

Warning:  Don't report hydration therapy for drug administration fluid

You can avoid submitting a deadly coding combination and pinpoint the correct code for multiple substance infusions if you use these tips and guidelines.

Match 90765-90768 With These Terms

When staff members administer infusions that involve more than one drug or substance, correct coding requires you to identify the material's status. You may specify the IV infusion with one base code and two add-on codes including:

• 90765--Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

• +90766-... each additional hour, up to 8 hours (list separately in addition to code for primary procedure)

• +90767-... additional sequential infusion, up to one hour (list separately in addition to code for primary procedure)

• +90768--... concurrent infusion (list separately in addition to code for primary procedure).

IV infusion codes 90765-90768 require you to know these terms:

• Initial--You should report 90765-90766 for the initial infusion that represents "the key or primary reason for the encounter, regardless of the order that the injections occur," says Rhonda Buckholtz, CPC, practice administrator at Wolf Creek Medical Associates in Oil City, Pa. Be careful: Staff may administer the drug that counts as the initial infusion in a second or third IV bag.
 
• Sequential -- Use 90767 to describe an infusion of a different drug immediately following the initial infusion. Catch: "If there is more than one substance in the bag, you would only use the code once," Buckholtz says. CPT intends the administration codes to capture "the separate work of administration and access and not the inclusion of multiple agents in a bag prepared prior to access."

• Concurrent--When staff administer multiple infusions through the same IV line, you should assign 90768, says Buckholtz, who is also president of the Oil City Chapter American Academy of Professional Coders (AAPC). Warning: "Report 90768 only once per encounter," according to CPT's parenthetical note following 90768.

Include Incidental Hydration in Drug Infusion Code

You now know how to code for infusions involving multiple drugs, but what rules apply to infusions of saline solution with medication? You shouldn't separately report fluid used to administer drugs, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the AAPC National Advisory Board. "The CPT guidelines classify this as incidental hydration."

Example: An internist administers Phenergan and a 250-cc bag of common saline solution through an IV for a patient who had diarrhea and vomiting. The infusion lasts 30 minutes.

In this case, you should code only the drug infusion (90765) and the medication (J2250, Injection, midazolam HCl, per 1 mg) if you supplied the Phenergan, says Patricia Davis, CPC, business office supervisor at Middlesex Health System Primary Care in Middletown, Ct. "Because the physician administers the drug through the same IV, coding both the hydration and the drug infusion would be double-dipping."