Billing Tips For Infusion, Injection And Hydration Services

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Billing Tips For Infusion, Injection And
Hydration Services
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Billing Tips For Infusion, Injection And
Hydration Services

• Billing and coding for infusion, injection and
  hydration services is challenging due to detailed
  medical billing, coding and documentation
  requirements. To receive insurance payments you
  have to review accuracy of drug codes and
  associated billing units generate charges for
  infusion-administration services use accurate
  CPT/HCPCS infusion codes apply modifiers (if
  required) keep accurate and complete
  documentation and many more. By reviewing most
  common reasons for claim denials we shared
  billing tips for infusion, injection and
  hydration services so that you can avoid these
  billing pitfalls.
• Billing Tips for Infusion, Injection and
  Hydration Services
• Billing order for injections and infusion Among
  infusion and injections, infusion should be
  primary, injections/IV pushes next and hydration
  therapy last.
• Allowed initial services/ day Only one initial
  code is allowed per patient encounter unless two
  separate IV sites are medically reasonable and
  necessary. If the patient returns for a separate
  and medically reasonable and necessary
  visit/encounter on the same day, another initial
  code may be billed for that visit with
  appropriate modifier (for Medicare, use modifier
  59).
• Differentiating between an IV push and an IV
  infusion An IV push is an infusion of 15 minutes
  or less and requires that the health care
  professional administering the injection is
  continuously present to observe the patient. In
  order to bill an IV infusion, a delivery of more
  than 15 minutes is required for safe and
  effective administration.

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Billing Tips For Infusion, Injection And
Hydration Services

• Billing sequential infusion Following the
  completion of the first infusion, sequential
  infusions may be billed for the administration of
  a different drug or service through the same IV
  access. There must be a clinical reason that
  justifies the sequential (rather than concurrent)
  infusion. Sequential infusions may also be billed
  only once per sequential infusion of same
  infusate mix.
• There is no concurrent code for either a
  chemotherapeutic IV infusion or hydration. Can a
  concurrent infusion be billed?
• Billing concurrent infusion Any hydration,
  therapeutic or chemotherapeutic infusion
  occurring at the same time and through the same
  IV access as another reportable initial or
  subsequent infusion is a concurrent infusion.
  Concurrent administration of hydration is not
  billable via a HCPCS code and not separately
  payable. In general, chemotherapeutics are not
  infused concurrently, however if a concurrent
  chemotherapy infusion were to occur, the infusion
  would be coded with the chemotherapeutic unlisted
  code.
• Billing hydration Documentation must indicate
  that the hydration service is medically
  reasonable and necessary. It should not be an
  integral part of another service such as an
  operative procedure. The rate of infusion should
  be included in the documentation. When fluids are
  used solely to administer drugs or other
  substances, the process is considered incidental
  hydration and should not be billed. To code
  hydration as an initial service, hydration must
  be a medical necessity and administered for more
  than 30 minutes. Hydration of 30 minutes or less
  is not separately billable. The charges for an
  administration of 30 minutes or less should be
  reported with an appropriate revenue code but
  without a HCPCS or CPT code. Each additional
  hour of hydration infusion requires an initial
  service being delivered (hydration or other
  infusion/injection service).

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Billing Tips For Infusion, Injection And
Hydration Services

• Documenting stop time for an IV infusion for
  hydration Infusion times should be documented.
  Hydration of 30 minutes or less is not separately
  billable. When requested, providers should submit
  documentation indicating the volume, start and
  stop times, and infusion rate (s) of the solution
  provided. In the absence of the stop time the
  provider should be able to calculate the infusion
  stop time with the volume, start time, and
  infusion rate and code accordingly.
• Common Documentation Mistakes
• Incomplete documentation is one of the major
  reason for claim denials. Due to incomplete
  documentation, claims might get denied as such
  claims might fail to justify medical necessity.
  Below we shared common documentations mistakes
  done by providers.
• 1. Intravenous Infusion Hydration Therapy
• The physician order for hydration fluids
  administered during the encounter for drug
  administration, chemotherapy or blood
  administration is missing
• No distinction is made between hydration
  administration that is the standard of care,
  facility protocol and/or drug protocol for
  administration of hydrating fluids, pre- or
  post-medications
• Documentation is insufficient and does not
  support medical necessity of pre-hydration,
  simultaneous or subsequent hydration

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Billing Tips For Infusion, Injection And
Hydration Services

• 2. Infusion Services
• Documentation does not confirm administration
  through a separate access site
• Poor documentation for the line flush between
  drugs makes it impossible to determine whether
  compatible substances or drugs were administered
  concurrently or sequentially
• The inadequate documentation of the access site
  and/or each drugs start and stop times makes it
  impossible to determine whether compatible
  substances or drugs were mixed in the same bag or
  syringe or administered separately
• Start and/or stop times for each substance
  infused are often missing
• The documentation of infusion services was
  started in the field by emergency medical
  services (EMS) and continued in the emergency
  department (ED)
• Documentation of infusion services that were
  initiated in the ED continued upon admission to
  outpatient observation status
• Working with vendors on electronic health records
  (EHR) to implement revisions to electronic forms
  in order to comply with changing documentation
  requirements was difficult

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Billing Tips For Infusion, Injection And
Hydration Services

• Avoiding Documentation Pitfalls
• To avoid documentation mistakes,
• develop and/or revise documentation forms that
  conform to the coding guidelines for injections,
  IV pushes, and IV infusions
• clinical personnel should focus on patient care
  and ensure accurate and complete documentation of
  the encounter
• the pharmacist should communicate the
  classification of the drug, fluid or substance to
  aide in the correct application of procedure
  codes
• Medisys Data Solutions is a leading medical
  billing company providing complete billing and
  coding services for various medical billing
  specialties. We hope that billing tips for
  infusion, injection and hydration services shared
  in this article would help you to receive timely
  and accurate insurance payments. If you need
  billing and coding assistance for your practice,
  contact us at info_at_medisysdata.com / 888-720-8884

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