Coding for infusions and injections is a step-by-step process. Learn the steps for a clear understanding of the coding:
- Hydration
- Chemotherapy Infusion
- Different methods of infusion
- Types of injections involved in these treatments
- Subsequent and concurrent drug delivery
- Reporting of add on codes in certain circumstances
- Determining the appropriate HCPCS code(s) for drugs
- Reporting discarded drugs
- Reporting drugs that do not have a HCPCS code
- Deciding the medical necessity based on diagnosis code
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Lynn Anderanin
CPC, CPB, CPMA, CPPM, CPC-I, COSC
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Lynn is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.
As reimbursement decreases on services and drugs, it is important that providers are reporting all of the services that are payable to realize the maximum reimbursement for what they are performing. To do that, staff has to understand the complex coding of these infusions and injections.
Reporting the complex coding of infusions and injections is frequently based on the time in which that patient is receiving treatment, with additional codes to be reported for different drugs, prophylactic circumstances and different methods of delivering the treatments along with reporting the drugs administered based on the dosage given. There is also a method to report discarded drugs when it applies, which is important when the provider has purchased the drugs in advance, and need to at the very least, receive their money back on those drugs.
Patients that need IV therapy or chemotherapy are required to receive this therapy over a period of time very often in several sessions. The reporting of these services to the insurance companies require documentation to support the length of time the patient receives each drug(s) and the order in which the treatment is given. CPT® codes reported are chosen based on the time it takes for the patient to receive their treatment in addition to the combinations in which they are given. Once these codes and code combinations are determined, it is then realized what medications were received and the proper HCPCS codes are chosen, with the dosage, to report these drug(s) provided by the provider.
Insurance carrier guidelines dictate what condition(s) or neoplasm can be treated by each of these drugs, to identify the medical necessity for the patient to receive the treatment, and the insurance carrier to reimburse for the services. There are several methods in which these drugs can be administered and a combination of CPT® codes used for listing these methods.
Comments from past participants:
"Excellent session. Good, straightforward information."
"Great content - I learned new things."
"It was very informative and provides knowledge of how billing/coding works for IV Infusions."
Prod ID: 362