Medicare and private insurers finally have their coding requirements in sync. Now it's up to you to learn this new IV-therapy coding method.
CPT now breaks intravenous therapy into two groups:
Identify hydration therapy
Now you should separately identify hydration IV infusion using two time-based CPT codes. "Codes 90760-90761 describe IV infusion of a common prepackaged saline solution," Davis says. In these cases, you, or a staffer under your direct supervision, grabs the bag, hangs it, and hydrates the patient.
Use the therapy's time to assign the correct hydration therapy code. If the service is greater than 15 minutes, report the first hour of hydration infusion with 90760 (intravenous infusion, hydration; initial, up to one hour). If you, or the staffer that you directly supervise, conduct the therapy for an additional hour, you should also report 90761 (. . . each additional hour, up to 8 hours [list separately in addition to code for primary procedure]).
Base service time only on the infusion's administration time. Don't report services leading up to and concluding the infusion. These have already been included in the infusion service code.
For example, say you directly supervise an IV infusion of a 500 cc bag of common saline solution to a patient. You document that the infusion administration occurs from 2:20-3 p.m. Because the IV infusion lasts less than one hour, you should report the service with 90760.
Billing for drug infusion
When you use an IV to administer something other than a prepackaged fluid and/or electrolyte solution, use the therapeutic, prophylactic, and diagnostic infusion codes 90765-90768. The new codes allow you to bill for how you're providing drugs or other substances. "They represent drug infusion, just like 90772 represents drug injection," Davis says.
When the infusion involves administration of a single drug, choosing the correct code is relatively simple. "Use 90765-90766 based on the infusion's duration," Davis says.
If an infusion lasts less than one hour, report 90765 (intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to one hour). For infusions lasting longer than one hour, also use 90766 (. . . each additional hour, up to 8 hours [list separately in addition to code for primary procedure]).
Let's say you directly supervise IV infusion of two grams of ceftriaxone for a patient who has Lyme disease with objective evidence of neurologic abnormalities. Administration of the IV infusion lasts 45 minutes and involves one substance. Report the therapy as 90765 with 088.81 (other specified arthropod-borne diseases; Lyme disease). For the medication, bill J0696 (injection, ceftriaxone sodium, per 250 mg) with eight units.
Pay attention to time
Although you should use 90760 and 90765 only once per claim, the same rule doesn't apply to infusion add-on codes 90761 and 90766. You use these add-on codes for each additional hour of infusion. That means you can report 90761 and 90766 with multiple units based on the number of additional hours of infusion.