Pulmonology Coding Alert

Observe minimum infusion time on all codes

When your pulmonologist infuses a patient with multiple substances during the same session, you'll also need to know which infusion payers consider primary, or the claim could wind up being inaccurate. Further, you need to be sure to code for the proper type of secondary infusion, or you could risk denials.
 
Check out this expert advice on making the most of your multiple-substance infusion claims.

Code 'Initial' Infusion First

When coding multiple-substance infusion claims, report the initial infusion with 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour). If the initial infusion lasts more than an hour, include +90766 (... each additional hour [list separately in addition to code for primary procedure]) for each additional infusion hour, says Sarah L. Goodman, MBA, CPC-H, CCP, president and CEO of SLG Inc. in Raleigh, N.C.

Remember: In order to rightfully report 90765-90766, the session must meet the following requirements:

• The pulmonologist must be administering the infusion for therapeutic, prophy- lactic or diagnostic purposes.
• The pulmonologist must supervise the entire session.
• The infusion must last a minimum of 16 minutes.
• The infusion must not be an inherent component of another procedure, such as a CT scan.
• A healthcare professional must be in attendance during the entire session.

Note: Payers will deny any 90766 claim for less than 30 minutes of infusion time. For example, if a patient receives a 75-minute therapeutic infusion, you can report only 90765; you won't be able to account for the 15 minutes of infusion past the hour mark.

However, if the patient receives an infusion of a single drug that lasts one hour and 45 minutes, the physician would report 90765 for up to one hour and 90766 for the additional 45 minutes.

'Initial' drug is not always first: Payers consider the initial infusion the "main reason" the patient is seeing the pulmonologist, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga. The initial infusion is not necessarily the first drug the pulmonologist administers.

"The chronological order of the drugs, medications and/or substances infused is not important--what is critical is the primary reason for the patient to be there that day," Parman says.

Hierarchy Comes in Handy for Infusion Sessions
 
As a guide, Goodman uses this "unofficial hierarchy" of infusion services she culled from the APC Weekly Monitor. This list could come in handy when deciding how to code multiple infusion claims:

• chemotherapy infusions
• chemotherapy injections
• non-chemotherapy, therapeutic infusions
• non-chemotherapy, therapeutic injections
• hydration infusions.

"Regardless of the order in which the physician administers the infusions, report the 'initial' code for the service that falls highest on the (hierarchy) list,"  Goodman says.

Example: The patient presents to the pulmonologist's office for chemotherapy treatment, and the pulmonologist performs a therapeutic, non-chemotherapy infusion of antibiotics. The pulmonologist then performs a chemotherapy infusion.

According to the hierarchy, you should report the chemotherapy as the initial infusion. When a patient presents for chemotherapy, there will be a series of incidental infusions/injections in addition to the chemotherapy. But the primary reason for the encounter remains chemotherapy.

1 Drug at a Time? Choose Sequential Code

After coding for the initial infusion, you'll have to decide what type of secondary infusion the pulmonologist performed. If the pulmonologist orders a secondary infusion to be given immediately after the initial infusion, then he performed a sequential infusion, Goodman says.

When the physician provides a sequential therapeutic infusion, report +90767 (... additional sequential infusion, up to one hour [list separately in addition to code for primary procedure]) for the service.

Remember: Use 90767 only when the pulmonologist orders the initial drug or substance to be infused, then orders a subsequent infusion, Parman says. Also, the infusion must last at least 16 minutes to report 90767.

Example: An established patient presents to the office with an exacerbation of chronic obstructive pulmonary disease (COPD). The physician orders an antibiotic infusion, followed by an IV steroid infusion. The antibiotic infusion lasted one hour, and the steroid infusion lasted 50 minutes.

In this scenario, Parman says, you should report 90765 for the antibiotic infusion, and 90767 for the sequential steroid infusion. Since the pulmonologist ordered the services one after the other (sequentially), you can report both administration codes, Parman says.

Simultaneous Infusions? Choose Concurrent Code

When the pulmonologist orders all of the drugs to be given to the patient at the same time, a concurrent secondary infusion occurs. When this happens, you should report the concurrent infusion code +90768 (... concurrent infusion [list separately in addition to code for primary procedure]).

"The AMA defines a concurrent infusion as one in which multiple infusions are provided through the same intravenous line," Goodman says.

"This code reports the concurrent infusion of two therapeutic substances, or the concurrent infusion of a therapeutic substance and an antineoplastic substance," Parman says.

Remember: Use 90768 only once per encounter.
 
Leave Saline Admin Code off Claim

One thing that you should never code for when reporting multiple-substance infusion is any fluid the physician uses to administer the IV drugs. Payers always bundle this service into the infusion codes.

"Fluid used as the vehicle for the delivery of other drugs or substances is not separately reported. This would include a 'flush bag' or KVO bag of fluid such as saline or D5W," Parman says.