Infusion Coding – Always Confusion

Injections and Infusions coding is always confusing. Through this post will try to make the things clear in infusion coding and give a quality infusion coding. The basic rule while coding hydration, intravenous push, and IVPB is that there should be only one initial service code per encounter, unless there is a mention of two different IV routes. Selection of the initial code depends on the record and also the sequencing as per CPT. Will discuss in detail throughout this post.

Infusing normal saline only or with electrolytes is considered to be hydration. As per CPT, we have two hydration codes

Hydration

96360: This is an initial code. This is a first hour hydration code, which needs to be given more than 30 minutes and up to one hour. Hydration less than 30 minutes is ignored and not coded.

96361: This code is used for each additional hour of hydration more than 30 minutes.

For Ex:
Normal saline given for 55 minutes is coded to only 96360.
Normal saline given for 90 minutes is coded to only 96360 because the next hour is only for 30 minutes and cannot be coded for the extra hour.
Normal given for 93 minutes can be coded to 96360 and 96361 as there is an additional 33 minutes, which can be taken as additional hour.

Intravenous Push (IVP)
Intravenous push is an administration of therapeutic substance through IV route for less than or for 15 minutes. Even for IVPs, we have initial IVP and each additional IVP codes.

96374: This is an initial IVP given
96375: This is coded for each additional IVP of different drug or substance.
96376: This is coded for the IVP of the same substance given after the 30 minutes after the same substance administration. If the same substance is given within the 30 minutes of the same substance given, it is not coded.

For Ex:
Morphine IVP is coded to 96374
Morphine IVP and Pepcid IVP is coded to 96374 and 96375
Morphine IVP is given at 12.00 and next morphine is given at 12.10 and Pepcid is given at 12.15, then only 96374 and 96375 (for Pepcid) is coded. The second morphine is not coded, as there is only 10 minutes difference.

IVPB
Infusions of therapeutic substance through IV for more than 15 minutes are coded to IVPB. There are initial, subsequent, concurrent codes for coding these.

96365: This is coded to initial hour of infusion
96366: This is coded to each additional hour of infusion.
96367: This is coded to additional subsequent infusion.
96368: This is coded to concurrent infusion. This is coded only once per encounter.

For Ex:

· Zofran IVPB given for one hour coded to 96365.
· Zofran IVPB given for two hours is coded to 96365 and 96366. The second hour infusion should be more than 30 minutes to be coded as additional hour code.
· Zofran IVPB given from 12.00 to 1.00 and Pepcid from 2.00 to 3.00, the initial hour 96365 is coded and also 96367 is coded for subsequent infusion.
· Both Zofran IVPB and Pepcid given from 12.00 to 1.00. The initial 96365 and 96368 are coded showing both are running concurrently.

IM/SQ Injections:
We have only one code for IM/SQ injection.

96372 is coded to IM/SQ injection and can be used for each injection.