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]

Regardless of whether you are billing for a facility or profee/physician, the CPT guideline heirarchy is drug related not Dx driven. So if the patient receives a drug via an IV that trumps any hydration (base code) given. The reason for the visit does not determine CPT infusion code selection, drug type does. In your scenario given, it would be a 96374 (IVP therapeutic drug) followed by any remaining time documented that would support a 96361. The hydration must meet the minimum threshold of 31 minutes to use an hour of hydration, if the total push time is documented then that amount would need to be subtracted from the hydration time if there was over-lap.