Pulmonology Coding Alert

If staff infuses saline solution with medication, report a single code

When your pulmonology practice performs an infusion with multiple substances, you'll need to know exactly what types of substances the patient receives. With this info in hand, you can avoid submitting an incorrect coding combination and pinpoint the correct code for multiple-substance infusions.

To report these encounters correctly, you'll need to learn some new codes for 2006. This year, CPT introduced a section titled "Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy)." This group includes codes 90765-90768, which you'll use to report infusions with more than one substance.

Match 90765-90768 With These Terms

When your staff members administer infusions with multiple substances, your first step is to identify the material's status. You may specify the IV infusion with one base code and three add-on codes:

• 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).

Coding for the 90765-90768 family requires 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 members administer multiple infusions through the same IV line, you should assign 90768, says Buckholtz, who is also president of the Oil City Chapter of the American Academy of Professional Coders. 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 do you know which rules apply to infusions of saline solution with medication? You shouldn't separately report fluid that you use to administer drugs, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the Academy's National Advisory Board.  "The CPT guidelines classify this as incidental hydration."

Example: A pulmonologist's staff administers Phenergan and a 250-cc bag of common saline solution through an IV for a patient with diarrhea and vomiting. The infusion lasts 30 minutes.

In this scenario, you should code only the drug infusion (90765) and the medication (J2250, Injection, midazolam HCl, per 1 mg) if you supplied the Phenergan, according to Patricia Davis, CPC, business office supervisor at Middlesex Health System Primary Care in Middletown, Conn.

"Because the physician administers the drug through the same IV, coding both the hydration and the drug infusion would be double-dipping," Davis says.