Infusion & Injections Hierarchy Code Assignment.pptx

(1)

Infusion & Injections

Hierarchy Code Assignment

Melody Draper Hnatovic, RHIT, CHPS, CCS

June 2, 2018

(2)

Melody Draper Hnatovic, RHIT, CHPS,

CCS

Melody is the HIM Supervisor and Privacy Officer for Jefferson Healthcare in Port Townsend, WA. She has over 35 years in HIM and coding experience

and is an AHIMA approved ICD-CM/PCS trainer.

(3)

Agenda

 Overview

 Injection & Infusion CPT codes

 Hierarchy code assignment

 Special instructions and modifiers

 Case examples

 References

(4)

Disclaimer

 “CPT” is a registered trademark of the American Medical Association. Their codes, descriptions and manual content are copyright by the AMA. All rights are reserved by the AMA.

 This information has been abbreviated for a focused presentation for a specific audience. Verify all codes and information in a current CPT book.

 This information is based on CMS and Noridian guidance. Third-party payers may have varying specific guidelines.

 This information is considered current at the time of this presentation but may change throughout the year. Please check for current guidance on the CMS and Noridian websites.

 This presentation does not provide legal or billing advice.

(5)

Hydration

 96360 Intravenous infusion, hydration; initial 31 minutes to 1 hour

 96361 +each additional hour (add on code)

Hydration consists of pre-packaged fluid and electrolytes (eg, normal saline, D5-1/2 normal saline + 30mEq KCL/liter

Must meet medical necessity May not use for TKO of KVO

Must be at least 31 minutes or not coded

(6)

Therapeutic

 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

 96366 + each additional hour (add on code)

 96367 + additional sequential infusion of a new drug/substance, up to 1 hour (add on code)

 96368 + concurrent infusion (add on code)

 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular

 96373 intra-arterial

 96374 intravenous push, single or initial

 96375 + intravenous push, sequential intravenous push of a new substance (add on code)

 96376 + each additional sequential intravenous push of the same substance/drug provided in a facility

 96377 Application of on-body injector (includes cannula insertion for timed subcutaneous injection)

(7)

Chemotherapy

 96401 Chemotherapy administration, subcutaneous or

intramuscular; non hormonal anti-neoplastic

 96402 Hormonal anti-neoplastic

 96405 Chemotherapy administration; intralesional, up to and including 7 lesions

 96406 intralesional, more than 7 lesions

 96409 Intravenous, push technique, single or initial substance/drug

 96411 + Intravenous, push technique, each additional substance/drug (add on code)

(8)

Chemotherapy continued

 96413 Chemotherapy administration, intravenous infusion

technique; up to 1 hour, single or initial substance/drug

 96415 + each additional hour (add on code)

 96416 Initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump

 96417 + each additional sequential infusion (different substance/drug, up to 1 hour (add on code

(9)

New Chemotherapy Effective

07/01/2017

 G0498 Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/other outpatient setting using office/other outpatient setting pump/supplies, with continuation of the infusion in the community setting(eg., home, domiciliary, rest home or assisted living) using a portable pump provided by the

office/other outpatient setting, includes follow up office/other outpatient visit at the conclusion of the infusion.

 9000 injection, doxorubicin hydrochloride, 10 mg (Adrimycin, Doxil, Caelyx, Myocet and others)

 J9181 injection, etoposide, 10 mg (Toposar, Etopophos)

 J9190 injection fluorouracil, 500 mg (Efudex, Carac, Fluotoplex, Adrucil)

 J9352 injection, trabectedinYoundelis®, effective DOS 01/01/2017 (use J3490 (OPPS: C9480) for DOS prior to 01/01/2017

 J9371 injection, vincristine sulfate liposome, 1 mg (Oncovin, Vincar PFS). Note: Check with carriers to see if they are accepting this new code

https://med.noridianmedicare.com/web/jfb/article-detail/-/view/10534/chemotherapy-administration-r7

9

(10)

Medicare update 04/01/2018

Effective date 01/01/2018, providers are instructed to use 96377 for the on-body application injector for Neulasta® Onpro Kit (pegfilgrastim) J2505.

(11)

Non-Chemo Drug Exceptions

Because of the documented increased infusion reactions and/or other reasons

necessitating increased administration practice expense or because of unmistakable use just as a chemotherapy drug, Noridian agrees with the use of an appropriate chemotherapy administration code for an infusion(or IV push) of the following drugs:

Examples (not all inclusive): Infliximab (Remicade) J1745

Avelumab (Bavencio®) J9023 Effective 01/01/2018 Ocrelizumab (Ocrevus) J2350 Effective 01/01/2018

Infliximab-abda biosimilar Q5104 Effective 04/01/2018 (Renflexis)

(12)

Additional Rules

 Therapeutic infusions must run for at least 16 minutes. 15 minutes or less is coded as a push.

 There must be 31 minutes or more between injections to bill sequential push of same drug.

 Cannot code hydration as concurrent. Code only the therapeutic/chemo infusion.

 Start and Stop times and anatomic sites (including laterality) must be documented to properly charge for infusions, otherwise it will be

expected to be coded as a push.

(13)

Modifier -59

 -59 modifier may be used to:

 Identify multiple encounters in same day.

 Example: If a patient returns for a separate encounter for antibiotics 2 times per day.

 Identify two separate IV sites and are medically reasonable and necessary.

 Example IV site left AC and IV site right AC.

(14)

There Can Be Only One!

 There can be only 1 initial per patient encounter.

(15)

Hierarchy

 Chemotherapy

 Infusion

 Injection

 Therapeutic

 Infusion

 Injection

 Hydration

 IM/SQ injections

(16)

Let’s Crack the Sequence of Codes

(17)

Code This Scenario #1

 Morphine 2 mg slow IVP over 2 minutes 15:48

 Protonix 40 mg IVPB in 50 ml NS over 15 minutes

 IV fluids started 1000 ml NS; 250 ml/hr 16:00

 IV fluids rate decreased to 125 ml/hr 17:06

 IV fluids stopped and IV SL locked.

(18)

Scenario #1 Answers

 Protonix 40 mg IVPB in 50 ml NS over 15 minutes

 IV fluids started 1000 ml NS; 250 ml/hr 16:00

 IV fluids rate decreased to 125 ml/hr 17:06

 IV fluids stopped and IV SL locked 18:00

(19)

Code this Scenario #2

 Nitroglycerin IV drip right AC 09:00-11:00

 Morphine drip IV left AC 09:00-10:00

(20)

Scenario #2 Answers

 Nitroglycerin IV drip right AC 09:00-11:00

 Morphine drip IV left AC 09:00-10:00

(21)

Code This Scenario #3

 Magnesium sulfate in D5W 08:00-09:30

 Zofran in D5W IV 10:30-10:45

 Panitumumab (Chemo) IV 11:07-12:07

 Oxaliplatin (Chemo) IV 12:30-13:55

(22)

Scenario #3 Answer

 Magnesium sulfate in D5W 08:00-09:30

 Zofran in D5W IV 10:30-10:45

 Panitumumab IV11:07-12:07

 Oxaliplatin (Chemo) IV 12:30-13:55

(23)

Code This Scenario #4

 Denosumab (Xgeva) SQ 12:35

 Fulvestrant (Faslodex) (Chemo) IM 12:18

(24)

Scenario #4 Answers

 Denosumab (Xgeva) SC 12:35

 Fulvestrant (Faslodex) (Chemo) IM 12:18

(25)

Code this Scenario #5

 Avastin IV (Chemo) 09:50-11:50

 Oxyplatin IV (Chemo) 11:00-13:00

 Fluorouracil IV (Chemo) 13:00

 Fluorouracil implantable pump over 46 hours 13:15

 Leucovorin IV 11:00-13:00

(26)

Scenario #5 Answers

 Avastin IV (Chemo) 10:00-12:00

 Oxyplatin IV (Chemo) 11:00-13:00

 Fluorouracil IV (Chemo) 13:00

 Fluorouracil implantable pump over 46 hours 13:15

 Leucovorin IV 11:00-13:00

(27)

Code this Scenario #6

 Cytoxan IV (Chemo) 17:10-17:40

 Dexamethasone IV 16:04-1619

 Adriamycin IV (Chemo) 16:40-16:50

 Emend IVPB 15:25-15:55

 Aloxi IVPB 14:59-15:14

 Neulasta Onpro SQ 18:23

 Sodium Chloride(NS) 500 ml IV to reduce kidney/bladder irritation 14:07-15:08

(28)

Scenario #6 Answers

 Cytoxan IV (Chemo) 17:10-17:40

 Dexamethasone IV 16:04-1619

 Adriamycin IV (Chemo) 16:40-16:50

 Emend IVPB 15:25-15:55

 Aloxi IVPB 14:59-15:14

 Neulasta Onpro SQ 18:23

 Sodium Chloride(NS) 500 ml IV to reduce kidney/bladder irritation 14:07-15:08

(29)

Code this Scenario #7

Patient ordered to have Rocephin IV 2 times per day in outpatient infusion clinic

 Rocephin IV 08:00-10:00

(30)

Scenario #7 Answers

Patient ordered to have Rocephin IV 2 times per day in outpatient infusion clinic

(31)

Questions ?

31

(32)

References:

https://med.noridianmedicare.com/web/jfb/article-detail/-/view/10534/chem otherapy-administration-r7 https://med.noridianmedicare.com/documents/10542/2840524/Drugs+and+B iologicals+Outpatient+Billing+Presentation https://med.noridianmedicare.com/documents/10546/12461379/Chemother apy+Administration https://med.noridianmedicare.com/documents/10542/2840524/Drugs+and+B iologicals+Outpatient+Billing+Presentation https://www.google.com/search?biw=1680&bih=955&tbm=isch&sa =1&ei=zDP7WsjPJcPQjAOD9534Cg&q=safe&oq=safe&gs_l =img.3..35i39k1j0i67k1l7j0l2.2605.5410.0.5597.18.11.0.0.0.0.235.901.6j2 j1.9.0....0...1c.1.64.img..13.5.677.0...0.aCLpbKdmTF8#imgrc=wgpCOH9f-Fs GNM:& spf=1526413731171 http://www.caltrc.org/wp-content/uploads/2013/07/medical-reimbursement. jpg https://www.google.com/search?q=there+can+be+only+one&source= lnms&tbm=isch&sa=X&ved=0ahUKEwjW4fWfm5fbAhUDyGMKHW9GA6gQ_AUIC igB&biw=1680&bih=955#imgrc=U7sNHLRQnGF3lM:&spf=1526919731398