Medicare Compliance & Reimbursement

AMA adds category for hormonal agents to drug administration codes.

Physicians that are struggling to come to grips with the new drug administration CPT codes for 2006 can get a head start with the following primer.

The basics: The American Medical Association has released the section of the 2006 CPT update including the codes for drug administration. The new codes are similar to the "G" codes doctors have been using for drug administration this year, but some concepts are spelled out in more detail.

Key idea: The new update includes more about the concepts of "initial," "subsequent" and "concurrent" infusion, says Kristi Downey, practice manager with Grand Rapids, MI Ob-Gyn physician Gary Downey. A doctor can only have one initial service per encounter, unless she has two different IV sites.

When providing a patient with an hour of infusion followed by an IV push, physicians should bill for the IV push using a subsequent IV push code--even though it's the first push they're providing, the AMA explains.

It's important to bear in mind that the initial code isn't necessarily (or even usually) the first drug administered, Downey stresses. The initial code is the primary reason for the encounter, so for a chemotherapy service, the main chemotherapeutic drug will be the initial infusion code.

The new codes break out some specific drugs, such as hormonal agents (90772 and 94602) that didn't have their own category before. They contain hydration codes (90760-90761) that correspond to this year's "G" codes. The AMA clarifies that an IV push is less than 15 minutes and requires a health care professional to be continuously present. Chemotherapy drugs include anti-neoplastic agents used for non-cancer diagnoses.

The new codes use the same time breakdown as the "G" codes, including the first hour, followed by each additional hour. Each additional hour must be 31 minutes or more, Downey cautions. Doctors should bill for more than eight hours as "prolonged infusion," and should use the actual time over which they administer infusion to report time-based codes.

Find it online: To find the drug administration codes, go to www.ama-assn.org/ama/pub/category/3113.html and click on "2006 drug administration codes." Then look for the "What's New" feature.