Oncology & Hematology Coding Alert

Question: Should I apply the 30-minute rule to initial infusions?

Wisconsin Subscriber

Answer: No, the 30-minute rule (that documentation must show 31 minutes or more to justify coding  for a subsequent hour of infusion) doesn't apply to initial infusion codes.
     
If the initial infusion is 16 minutes or more, report the code for -initial infusion, up to one hour- (such as 90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour). Remember: IV push codes describe infusions of 15 minutes or less.
    
You should apply the 30-minute rule to the subsequent hour of the infusion. Do this: If the subsequent -hour- is 30 minutes or less, don't report an additional code. If the subsequent -hour- time is 31 minutes or more, report the code for an additional hour of administration.
    
Example: The total infusion time is 75 minutes. The 30-minute rule says you can only code the initial hour, because you have 1 hour of initial infusion time but only 15 minutes of a subsequent hour. Fifteen minutes is less than 31 minutes, so you can't code a subsequent hour.