CPT Coding Guidelines Review: Injections and Infusions

This is a series of blogs about the importance of being familiar with CPT coding guidelines. Often there is extensive guidance preceding a subsection or range of codes for particular procedures, but coders are very busy so sometimes they jump right into the codes without taking time to review these guidelines, even though following or not following their direction could significantly affect the accuracy and comprehensiveness of coding.

This series is designed to help you become familiar with guidelines for significant procedures that you might not be acquainted with but do impact coding. The presentations are short and meant to generate awareness of the guidelines that are available in CPT rather than the application of guidelines to specific coding scenarios.

This installment of the series explores the guidelines related to CPT coding for injection and infusion procedures.

CPT Guidelines for Injections and Infusions

Please watch this presentation to learn about the guidelines that provide direction in assigning CPT codes for injections and infusions.

Take Aways

• Most injection and infusion codes are not reportable by the physician when these services are provided in the facility setting
• Physicians may report significant and separately identifiable E/M services provided during the same visit as an injection or infusion
• Only one initial service is reported per given date, unless protocol or patient condition requires a second IV access
• Injections or infusions administered in addition to the initial service are coded as subsequent or concurrent services
• Physicians determine the initial service based on the key or primary reason for the encounter
• Facilities determine initial service based on a hierarchy of services and administration methods
• Hydration/fluids administered with another drug/substance/agent are considered incidental hydration and not reported separately
• Do not report administrations provided simply to keep an access site open
• An infusion of 15 mins or less is considered an IV push
• Hydration services are reported per hour, a minimum of 31 minutes must elapse before an hour of service may be reported.

Test Your Knowledge

For detailed explanations of the quiz answers, please refer to the end of this blog post.

Additional Coding Education: Invest in You!

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Quiz Answers and Rationale

Question 1: The answer is 91. Hydration is reported per hour of administration. 31 minutes of administration must elapse before the first hour of administration may be reported. Once an hour (60 mins) has elapsed another 31 mins of hydration must be administered before a second hour of hydration can be coded. 60 mins plus 31 mins equals 91 mins.  

Question 2: The answer is Chemotherapy is primary to therapeutic, prophylactic and diagnostic, which is primary to hydration. When coding for injections and infusions administered in the facility setting, selection of the initial service is based on a hierarchy where chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are in turn primary to hydration services.

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.