Pulmonology Coding Alert

90784 isn't an infusion cure-all

If you simply report 90784 when the physician spends an hour performing intravenous drug infusion, you'll forfeit about $65 - the difference between reimbursement for 90784 and 90780. Let our coding experts walk you through a few simple steps to help your practice collect for 90780 and 90781 every time.
 
Injection Codes Depend on Time

When a physician administers drugs intravenously for an hour or less, you should report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour).   This code covers the infusion of medication or fluids into the patient for a prolonged period of time, says Terry Bilier, MA, CPC, CCP, quality assurance auditor at Lexon Medical Resources in Henderson, Nev.

Don't miss: You may also report add-on code +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) for each additional hour that it took the physician to complete the infusion of medication or liquids into the patient, Bilier says.

Example: Your physician uses inhalation therapy to administer intravenous immunoglobulin (IVIG) (J1563) to a patient diagnosed with hypogammaglobulinemia (279.00, Hypogammaglobulinemia, unspecified). You would not report 90784 (Therapeutic, prophylactic or diagnostic injection; intravenous) in this case, unless the physician adds a drug as a bolus or "push" because the physician did not administer the medication directly into the vein.

Because the therapy lasted one hour and your physician provided the services, you should report 90780, Bilier says.

If the nurse administers the drug, you can bill 90780 as an "incident-to" service, Bilier adds. But make sure your physician is immediately available in the office suite if someone else administers the infusion, according to the Medicare Carriers Manual section 2050.1.

CPT defines "incident-to" as procedures performed by the physician or under the "direct" supervision of the physician. Medicare requires the physician to be present in the "office suite" but not necessarily in the patient room during the service for a physician to provide "direct supervision."

Tip: You should always pay attention to the infusion time. If the Albuterol therapy lasts two hours, you should report +90781 along with 90780. The add-on code pays an average of about $35, up from $21 in 2003.

Remember: As always, with any add-on code, make sure you report the correct corresponding ICD-9 code with the add-on code (e.g., 90781).

Make no mistake: "The 'plus' designation identifies those procedures that the physician performs in addition to other, usually closely related, procedures or services," says Tara L. Conklin, CPC, an instructor for CRN Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification and inpatient coding certification. "That's why they are called 'add-on' codes: You cannot report them alone, but always 'add them on' to another procedure or service."

Report Infusion Differently Depending on Payer

Medicare publishes different infusion reporting rules than other payers, so make sure you pay close attention to your payers' guidelines.

Most carriers will pay for IV infusion as long as the infusion is medically necessary. As for push medications, "most carriers will accept an IV infusion with the IV push drug, 90784, with modifier -59 (Distinct procedural service) to show that it was a distinct, separate procedure," says Karen Marsh, president of Kare-Med Consulting in Jensen Beach, Fla. Others, however, will not allow you to report 90780 with 90784-59. 

The National Correct Coding Initiative bundles these two services and does not allow you to unbundle them with modifiers. The code status "T" for these codes prevents any practice from receiving separate and additional reimbursement for each of these procedures. If you bill to a carrier that pays for both, make sure you understand the difference between the two services.

The difference: If you report 90784, make sure it was administered as a "push" medication into the infusion port and that it was meant for the direct injection of a substance into the patient's vein, coding experts say.  

Warning: You may also be eligible to report infusions to Medicare with Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit) billed by hospital facilities under the hospital outpatient prospective payment system, not by private practices. But if you bill a private payer, report only 90780 and 90781 because most insurers won't accept Q codes, which only cover labor and supplies. If you want to collect reimbursement for the drugs, code the drugs separately.

Note: Look to Article 4 for a quick update on the "status" of these codes and how you can determine what is separately payable.