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.
- 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).
- 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
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 drug’s 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
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@medisysdata.com / 888-720-8884
Reference: Medicare Local Coverage Article: A53778
