Health Information Management

Q&A: Coding drug administration for observation patients

APCs Insider, November 22, 2013

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Q: An observationpatient received an IV push on the first day (9/28) and an infusion the next day (9/29). The department reported CPT® code 96374 (therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug) on 9/28 and add-on code 96366 (intravenous infusion, each additional hour) on 9/29. Should we report another initial service on 9/29 since it is a new date of service?

A: Observation services are considered to be a continuous service and one encounter under Medicare.

According to CPT guidelines, drug administration services are reported based on a hierarchy that spans the entire encounter. The information notes that an IV push and a drug infusion occurred during this observation encounter. Based on the published hierarchy, infusion services are the primary service when considered with injections.

Assuming that the documentation supports the time requirement for the codes referenced and different drugs were given, the drug infusion would be reported as 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug); initial, up to 1 hour) and the IV push reported as add-on code 96375 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug).

 If the same drug was given by infusion and IV push, the push would be reported with 96376 (each additional sequential intravenous push of the same substance/drug provided in a facility, list separately in addition to code for primary procedure).

CMS Claims Processing Manual, chapter 4, section 280.2 states:

Drug administration services are to be reported with a line item date of service on the day they are provided. In addition, only one initial drug administration service is to be reported per vascular access site per encounter, including during an encounter where observation services span more than one calendar day.

 

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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