Coding Essentials for Infusion and Injection Therapy Services 2018

Transcription

1 Coding Essentials for Infusion and Injection Therapy Services 2018 A guide for outpatient injections, non-chemotherapy and chemotherapy administration services Prepared and Published By: MedLearn Publishing A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN

2 Section 1: Fundamentals Introduction...1 Scope...1 Promoting Financial Excellence...2 Organization of This Book...3 Chapter 1: Medicare Payment Primer...5 Coding Systems...5 Place of Service...13 Appropriate Use of Modifiers...16 Claims Processing...19 Reasonable and Necessary Services...23 Not Reasonable and Necessary...25 Medicare Recovery Audit Program...26 Chapter 2: Clinical Background...29 Infusion Types...30 Documentation Requirements...32 Chapter 3: Business Processes and Operations...37 Elements of the Data Flow...37 Evaluating the Data Flow Process...39 Chapter 4: Charge Reconciliation and Auditing...51 Charge Reconciliation...51 Auditing...52 Process and Procedure Tips...53 Section 2: Hydration Chapter 5: Hydration Therapy...57 CPT/HCPCS Codes...57 Intended Use...57 Billing Tips...60 Drugs...63 Case Study Claims: Hydration...63 Section 3: Drug Administration Chapter 6: Intravenous Infusion...67 CPT/HCPCS Codes...67 Intended Use...67 Billing Tips...72 Drugs...74 Case Study Claims IV Infusion...75 iii

3 Chapter 7: Subcutaneous Infusions...79 CPT/HCPCS Codes...79 Intended Use...79 Billing Tips...80 Drugs...80 Chapter 8: Injections: Intravenous...81 CPT/HCPCS Codes...81 Intended Use...81 Billing Tips...83 Drugs...85 Case Study Claim: IV Push in the Emergency Department...85 Chapter 9: Injections: Subcutaneous, Intramuscular, or Intra-arterial...89 CPT/HCPCS Codes...89 Intended Use...89 Billing Tips...90 Drugs...92 Case Study Claim: IM/SQ Injection...92 Section 4: Chemotherapy Chapter 10: Chemotherapy: Injections...97 CPT/HCPCS Codes...97 Intended Use...97 Billing Tips...98 Drugs...99 Case Study Claim: Intramuscular Injection of Chemotherapy Chapter 11: Chemotherapy: Intravenous Push CPT/HCPCS Codes Intended Use Billing Tips Drugs Case Study Claim: Chemotherapy IVP Chapter 12: Chemotherapy: Intravenous Infusion CPT/HCPCS Codes Intended Use Billing Tips Drugs Case Study Claim: Chemotherapy IV Chapter 13: Chemotherapy: Implantable and Portable Drug Delivery Systems CPT/HCPCS Codes iv

4 Intended Use Billing Tips Drugs Case Study Chapter 14: Chemotherapy: Other Modes of Administration CPT/HCPCS Codes Intended Use Bundled Procedure Billing Tips Case Study: Intraperitoneal Chemotherapy Section 5: Other Procedures Chapter 15: Blood Collection CPT/HCPCS Codes Intended Use Billing Tips Chapter 16: Transfusion of Blood and Blood Components CPT/HCPCS Codes Intended Use Billing Tips Chapter 17: Therapeutic Pheresis CPT/HCPCS Codes Intended Use Billing Tips Chapter 18: Declotting Vascular Access Device CPT/HCPCS Codes Intended Use Billing Tips Chapter 19: Vaccines and Toxoids CPT/HCPCS Codes Intended Use Billing Tips Chapter 20: Therapeutic Phlebotomy CPT/HCPCS Codes Intended Use Billing Tips v

5 Section 6: Pharmacy Chapter 21: Coding for Drugs and Biologicals Level II HCPCS Codes: Usage and Format Revenue Codes Documentation for Drugs and Biologicals Documentation of Medical Necessity Drugs Furnished Incident to a Physician s Service Drugs Billed as Supplies Billing Tips Section 7: Observation Chapter 22: Observation Accounts Drug Administration Coding Billing Tips Appendices Appendix A: Correct Coding Edits for Hospital Outpatient Infusion Services Appendix B: Correct Coding Edits for Practitioner Infusion Services Appendix C: Avoiding Drug Name Confusion Appendix D: Avoiding Error-Prone Drug Documentation Appendix E: Coding for Drugs and Biologicals Appendix F: Local Coverage Determination for Drugs and Biologicals vi