Practice Management Alert

 Question: Our practice performs in-office infusions that keep the patient in the office for up to six hours. Carriers deny our charges for the infusion code plus prolonged service codes to account for the extended service time, stating they do not pay for prolonged services in the office setting. Does this mean they would reimburse the same claim in a hospital setting? Is it possible to report a different place-of- service code in order to secure payment? Or is there a better way to get reimbursed for these services?

- California Subscriber

Answer: You cannot redefine your place of service in order to secure payment. If you are an outpatient office (place-of-service code 11), there is no way for you to qualify as an outpatient hospital setting (place-of-service code 22) because you would need to have the capacity to admit and treat inpatients.
 
As for payers stating they don't reimburse prolonged services in the office setting, that doesn't make much sense. Perhaps what they mean is they don't pay on prolonged service codes when you report them with an infusion code. Prolonged service codes report continuous face-to-face contact between the physician and the patient, and it's unlikely that a physician is directly supervising all six hours of an infusion service. Therefore, prolonged service codes are inappropriate for this service.

The better way to bill for your infusion services and the extended time involved would be with the intravenous infusion code 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and the add-on code +90781  (... each additional hour, up to eight hours [list separately in addition to code for primary procedure]). So if you perform an infusion that lasts six hours, you should report 90780 once and then 90781 five times.