Wiki First hour of service

[flms]

In the February 2013 Cutting Edge Monthly magazine entitled "infuse a dose of coding" the test yourself question posed was "If a code is reported as the first hour of service, what is the minimum amount of time that must be documented to report that code. The correct answer was posted as 31 minutes. I have received conflicting rationale from a CPC and a CHONC.
Please offer rationale.

 

[OCD_coder]

Go to your CPT book at front and in the TIME guidelines you'll find the following description:

A unit of time is attained when the mid-point is passed by CPT definition. Time is the sum total for a single date of service, it does not need to be contiguous. Time cannot be combined between providers. For example a patient may spend time with both a NPP and their supervising provider on the same date of service, only the time spent with one provider is counted not both.


Example: An hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed.

Note: This applies to any CPT code that is time based with a description of "First hour" or 60 minutes.

 

[alannae]

The confusion for infusion coding is if the 'initial' infusion lasts between 16 minutes and 30 minutes.

If the initial infusion is 15 minutes or less, an initial 'push' code is billed (96409, 96374).

If the initial infusion is 16 to 90 minutes, an initial infusion code is billed (96413, 96365). You cannot bill an additional 'hour' (96415, 96366) unless the infusion of the inital drug is 91 minutes or longer.

I apologize, I don't have access to any references at the moment but maybe someone can post some additional reference material.

I didn't read that article. I guess I'm going to have to go look at it now!

Alanna Esler, BS, CPC, CHONC

 

[kaa008]

>31 refers to the first hour of hyration (96360) and 16 minutes or longer refers to the therapeutic or chemo infusion codes (96365 or 96413). Anything less than 31 minutes for hydration cannot be billed (cannot combine times) and anything less than 16 minutes for therapeutic or chemo is considered a push. I hope this helps.