Pulmonology Coding Alert

Our quick update on 'A' and 'T' status leads you to the right infusion code

Not all infusion codes are alike. Although you may be able to collect reimbursement for 90780 if you perform IV infusion with other procedures, you should expect payers to bundle your 90784 claims into other charges.

If you report infusion codes such as 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected];  intravenous), you should check the Medicare Physician Fee Schedule to guide your correct coding.

According to the fee schedule:

A = Active Code. Medicare pays these codes separately under the fee schedule, if covered. An "A" indicator means that Medicare has not made a national coverage determination regarding the service; regional carriers remain responsible for coverage decisions in the absence of a national Medicare policy.

T = Injections. Medicare lists RVUs and payment amounts for these services, but only pays them if you don't perform any other payable services on the same date. If the physician performs any other services payable under the fee schedule on the same date, these services are bundled into the payment for the other services. (This is a change from the previous definition, which stated that coders should bundle injection services into any other services billed on the same date.) Note: Medicare does assign other non-injection codes this status (e.g., 94760, 94761).

Don't forget: When it comes to the infusion codes 90780 and 90784, 90780 carries an "A" status. This means that 90780 is separately payable. But 90784 has a "T" status, which means that it is not separately payable if you report it with any other payable service on the same date, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Private payers may allow you to report 90784 for additional reimbursement, so always check your local carrier's guidelines. But remember, Medicare and any payer that follows Medicare guidelines will not reimburse you separately for 90784 when you perform it with other payable services, Pohlig says.