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Below are answers to key questions on coding and billing infusion services in rheumatology practices.
No, a nurse visit (99211) cannot be billed with any of the drug administration codes. Currently, CPT indicates that infusion services typically require direct supervision with these services and nurse’s work is an integral part of the main infusion procedural codes 96401-96413.
Drug administration services are “time-based” codes, and time documentation is critical as this drives the accuracy of the codes reported. Per the AMA, an infusion is measured once the medication is actually running (pre and post time are not counted) – this is often called “drip to drip”.
No, the CPT guidelines and hierarchy must be followed. Only one initial code can be billed from the drug administration code set per encounter unless there is more than one IV access site – order of service delivery does not determine what is “initial.” The claim should be coded with 96413 initial chemotherapy infusion and 96375 each additional push.
If saline is used concurrently with the administration of the drug, it is not allowed to be billed. If saline is used to flush a medication because the patient had an adverse reaction, then the hydration code can be billed. Remember, only one initial code is allowed per the encounter and the modifier -59 should be added to the subsequent code which indicates that the hydration was a distinct and separate reason. Documentation must indicate that the hydration service is medically reasonable and necessary.
No, supplies used during an infusion cannot be billed in addition to the infusion code as they are considered a component of the service.
Practice Management Coding Staff