2010 UBO/UBU Conference

Title: Common Coding Errors in IV Services

Session: W-5-1530

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Overview

When common coding errors occur such as: – hydration services not just for dehydration– infusion versus push– initial versus add-on/subsequent– included and not reported separately

Hierarchy Basics Timing is everything What is:

– concurrent– subsequent

Hierarchy Basics…..

Hierarchy

Chemo Infusion/Injection

Therapeutic Infusion/Injection

Pushes

Hydration

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“Initial” Group

Each group has at least one initial service code:– Initial Chemotherapy infusion 96413 (16 min up to 1

hr)– Initial Chemotherapy injection 96409– Initial Therapeutic Infusion 96365 (16 min up to 90

min)– Initial Therapeutic Push 96374– Initial Hydration 96360 (31 min up to 90 min)

*Initial or first hour of infusion (therapeutic infusions) is from 16 to 90 minutes

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“Additional Service w/ New Substance” Group

Additional infusions/injection of a new substance will be coded with sequential (or concurrent)codes:– sequential chemotherapy infusion 96417 (16 min up

to 90 min)– sequential chemotherapy injection 96411– sequential therapeutic infusion 96367(16 min up to 90

min)– sequential therapeutic push 96375– sequential hydration 96361 (31 min up to 90 min)

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“Additional Time” Group

Add-on codes for infusions that run greater than 30 min beyond 1 hour increments:– each additional hour of chemo infusion 96415– each additional hour of therapeutic infusion 96366– each additional hour of hydration 96361

Additional hours of infusion (therapeutic infusions) only after more than 30 min have passed from the end of the previously reported hour

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Timing is Everything….

Documentation of the start and stop time is essential critical to distinguish if the drug administered is initial, sequential, additional, and current! – Time does not start until the drug starts

dripping!

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Hydration Coding Issues…

Many reasons and different diagnosis will warrant an order for hydration (96360 and 96361)…..such as nausea, vomiting, dizziness, pain, dehydration, etc. – not just for dehydration.– 96360: >30 min and <91 minutes….96361: >91

minutes

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Subsequent vs. Concurrent

Subsequent – comes after another service Concurrent – happens at the same time as another

service

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“Included and Not Reported Separately” Coding Errors

CPT states: services that are included and should not be reported separately – local anesthesia, IV start (Hep Loc placement), flushes, tubing and supplies

If the encounter is for the purpose of IV hydration only ….do not report the pre-packaged fluids, such as normal saline and electrolytes, etc. (example: J7030 or J7120)

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“Included and Not Reported Separately” Coding Errors

The catheter placement 36000 is not coded in addition to the IV services such as chemotherapy, therapeutic and hydration

Irrigation of implanted venous access device 96523 (aka “flush”) – is not reported if another service is provided on the same day

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Scenarios of Common Coding Errors

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Initial Services Coding Errors

Scenario 1:

Pt with bronchitis given IV antibiotic from 1010 to 1052. Dr. ordered Toradol to be given IVP. Pt given IVP Toradol. Pt tolerated well. Line dc’d and pt discharged with instructions.

Incorrectly coded:

96365 for the IV antibiotic

96374 for the IVP Toradol(Both codes are “initial codes” – making them incorrect to report)

Correct coding:

96365 (Intravenous infusion, therapeutic) – IV antibiotics

96375 (each additional push) – Toradol IVP

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Initial Services Coding Errors…

Scenario 2:

Pt with nausea and vomiting x 2days. Hydration of normal saline started 1015. Zofran IVP ordered and given @ 1020. Toradol IVP ordered and given @ 1100. Normal saline finished @ 1135.

Incorrectly coded:

96360, 96361 for the IV hydration

96374, 96375 for the IVP services.

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Correct coding:

96374 (Initial push) – Zofran IVP

96375 (each additional push) – Toradol IVP

96361 (additional hydration) – normal saline

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When Time Becomes A Coding Issue

Scenario 3:

Pt given the following –

Phenergan IVP @ 1100

Zofran IVP @ 1109

Phenergen IVP @ 1240

Incorrectly coded:

only reported 96374 IVP and 96375 IVP

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Correct coding:

96374 (initial IV push) – Phenergan IVP @ 1100

96375 (each additional push) – Zofran IVP @ 1109

96376 (IV push, same drug) Phenergan IVP @ 1240

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When Time Becomes A Coding Issue

Scenario 4:

25yr old with bronchitis. IV antibiotics ordered by physician. Started infusion @ 1300, pt resting. Pt dc’d @ 1415 with orders to f/u prn if symptoms return.

Incorrectly coded:

96365 (Intravenous infusion, therapeutic) - IV antibiotics

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Correct coding:

96374 (Initial push)

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Chemotherapy Coding Issues…

Scenario 5:

Ovarian Ca. pt presents for chemotherapy. GYN/ONC ordered Carboplatin and Taxol to be given thru pt’s PICC line. Pt’s PICC demonstrated good blood return and flushed w/ 10cc ns. 1ltr of NS started @ 0830 thru pt’s PICC line. Pt given Zantac and Colace po @ 0840. Carboplatin infusion started at 0915 and stopped at 1315. Taxol infusion started at 1415 and stopped at 1515. Line dc’d from pt’s PICC at 1545. PICC line flushed with 10cc ns. Pt tolerated procedure well.

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Incorrectly coded:

96413 (initial chemo infusion, up to 1hr) carboplatin

96415 (each additional hour chemo infusion)carboplatin

96417 (each additional sequential infusion, different drug) Taxol

96361 (additional hydration) normal saline

96523 (irrigation of implanted venous device) PICC Line

Correct coding:

96413 (initial chemo infusion, up to 1hr)

96415 (each additional hour chemo infusion)

96417 (each additional sequential infusion, different drug)

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Questions:

???????

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References

2010 AMA CPT Manual, Professional Edition Coding Clinic for HCPCS - First Quarter 2009 Page: 6-8 MHS Coding Guidelines 5.10.