Oncology & Hematology Coding Alert

Answer: The misconception that an intravenous (IV) treatment needs a time-based code stems from the second part of the CPT^® definition of an IV or intra-arterial push, which tells you that it is “an infusion of 15 minutes or less.” In fact, the first part of the definition, that a push is “an injection in which the individual who administers the drug/substance is continuously present to administer the injection and observe the patient,” is more helpful for pinpointing the correct code for the IV push you mention in your encounter.

If you think of a push as being a rapid, one-time dose of a medication, then 96374 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug) is the more appropriate code to use in your scenario, as this is a single, initial service implied by the word “push” in the descriptor. CPT^® code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour), on the other hand, implies an initial service that is lengthier and more complex than a simple, single injection.

Also, the package insert for paracetamol for infusion says it “must be administered as a 15 minute intravenous infusion” (fdaghana.gov.gh/img/pils/Paracetamol Kabi 10mg per ml solution for infusion (Paracetamol).pdf). Therefore, since the infusion instructions require it to be an infusion of 15 minutes, the payer may be assuming an IV push, not an infusion, is the correct route for billing.