Wiki Infusion coding

[Sephardic]

I have been researching infusion coding as I am trying to create a cheat sheet for a clinic, but am still confused on one point. The guidelines state that for physicians we should pick the initial code that best describes the key or primary reason irrespective of the order. Facilities must code based on the hierarchy stated in the CPT guidelines. It seems to me that if I follow the notations listed under the CPT codes that they will force me to code according to the facility heirachy. For example: What if I'm billing for a physician and the patient received hydration for an hour and an IV push (not concurrent) and hydration was considered to be the primary reason. Would I code 96360 and 96375. The notes under 96375 state it can only be used in conjuction with 96365, 96374 96409, 96413.(but not 96360) It feels like it's forcing me to make the push as the primary reason and use 96374 instead. Am I missing something totally obvious?

 

[OCD_coder]

You are correct, use the 96374 as your base code, then determine if the 96361 can be used if you have enough time documented. I think your overthinking it a bit and including the Dx in your thought process. Just focus on the infusion/push times and the drugs and it will come easier. See my answer to your 2nd post for more information.

Under the heading Initial Infusion:
.... an initial infusion is the key or primary reason for the encounter reported irrespective of the temporal order in....
Meaning: Code first the initial service based on the drug heirarchy, not the order they are given. You may have premeds given prior to the primary reason the service is rendered, but all medications (chemo or therapeutic) trump hydration.

.....For both physician....and facility reporting, only one initial service code should be reported....
Meaning: there is no discrepancy as to where the patient recieved the IV infusion, the rules are the same for Facility and Profee.