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 55101 1-800-252-1578 www.medlearnmedia.com
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
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...100 Chapter 11: Chemotherapy: Intravenous Push...103 CPT/HCPCS Codes...103 Intended Use...103 Billing Tips...105 Drugs...106 Case Study Claim: Chemotherapy IVP...107 Chapter 12: Chemotherapy: Intravenous Infusion...109 CPT/HCPCS Codes...109 Intended Use...109 Billing Tips...112 Drugs...113 Case Study Claim: Chemotherapy IV...113 Chapter 13: Chemotherapy: Implantable and Portable Drug Delivery Systems...115 CPT/HCPCS Codes...115 iv
Intended Use...115 Billing Tips...116 Drugs...117 Case Study...117 Chapter 14: Chemotherapy: Other Modes of Administration...119 CPT/HCPCS Codes...119 Intended Use...119 Bundled Procedure...120 Billing Tips...120 Case Study: Intraperitoneal Chemotherapy...121 Section 5: Other Procedures Chapter 15: Blood Collection...127 CPT/HCPCS Codes...127 Intended Use...127 Billing Tips...129 Chapter 16: Transfusion of Blood and Blood Components...131 CPT/HCPCS Codes...131 Intended Use...131 Billing Tips...132 Chapter 17: Therapeutic Pheresis...135 CPT/HCPCS Codes...135 Intended Use...135 Billing Tips...136 Chapter 18: Declotting Vascular Access Device...137 CPT/HCPCS Codes...137 Intended Use...137 Billing Tips...137 Chapter 19: Vaccines and Toxoids...139 CPT/HCPCS Codes...139 Intended Use...139 Billing Tips...140 Chapter 20: Therapeutic Phlebotomy...143 CPT/HCPCS Codes...143 Intended Use...143 Billing Tips...143 v
Section 6: Pharmacy Chapter 21: Coding for Drugs and Biologicals...147 Level II HCPCS Codes: Usage and Format...147 Revenue Codes...148 Documentation for Drugs and Biologicals...149 Documentation of Medical Necessity...149 Drugs Furnished Incident to a Physician s Service...150 Drugs Billed as Supplies...152 Billing Tips...152 Section 7: Observation Chapter 22: Observation Accounts...157 Drug Administration Coding...157 Billing Tips...159 Appendices Appendix A: Correct Coding Edits for Hospital Outpatient Infusion Services...163 Appendix B: Correct Coding Edits for Practitioner Infusion Services...167 Appendix C: Avoiding Drug Name Confusion...169 Appendix D: Avoiding Error-Prone Drug Documentation...189 Appendix E: Coding for Drugs and Biologicals...195 Appendix F: Local Coverage Determination for Drugs and Biologicals...203 vi