Presented by:

Vivian Blankemeier, CCS

Patricia Vargas, CCS
Prepared by:
Christi Gonzales, CCS

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 Codes for injections and infusions comprise
only five pages of the more than 700 in the
CPT manual, yet they continue to be among
the most difficult for coders to decipher.

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Review of Concepts

Hierarchy
Code Definitions

Documentation
Time
Physician Order
Substance Administration

Concurrent vs. Sequential Infusion

Hydration

Tips/Exercises

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 The CPT guidelines and hierarchy must be
followed:
One code in each category of intravenous infusion and injection
drug administration codes designated as the initial service.
Order of service delivery does NOT determine what is initial.
Typically only one initial service will be reported per encounter
unless there is more than one IV access site.
Chemo services are primary to therapeutic, prophylactic, and diagnostic
services, which are primary to hydration services.
Infusions are primary to pushes, which are primary to injections.
The hierarchy does not apply to physician reporting.
The hierarchy does not apply to SQ/IM injections, only intravenous
injections.

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 Facility coding of the Initial code should be
selected using the hierarchy below:
Chemotherapy Infusions
Chemotherapy Injections
Therapeutic, Prophylactic and Diagnostic Infusions
Therapeutic, Prophylactic and Diagnostic Injections
Hydration Infusions

When coding injections and infusions, always follow

the hierarchy regardless of the order in which services
were provided. Chemotherapy services are always
primary, meaning you must report them first.

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 Infusion Therapy 96365-96368
For purposes of facility coding, an infusion is required to
be more than fifteen (16+) minutes for safe and effective
administration.

Injection/IV Push Therapy 96374-96376

An intravenous injection (IV push) is an infusion of
fifteen minutes or less.

Hydration Therapy 96360-96361

IM/Subcutaneous Injection 96372

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Codes Description Time Duration
96360 Intravenous infusion; 31 minutes to one
Hydration; initial, 31 hour
minutes to 1 hour Do NOT report
hydration infusions
of 30 minutes or
less
96361 Intravenous infusion; Beginning at 91
Hydration; each minutes
additional hour
96365 Intravenous infusion; 16 minutes to one
for therapy, hour
prophylaxis, or Infusion less than
diagnostic; initial, up 15 minutes = IVP
to 1 hour

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Codes Description Time Duration
96366 Intravenous infusion, Beginning at 91
for therapy, minutes
prophylaxis, or Same Drug
diagnostic; each
additional hour (list
separately in addition
to primary code)

96367 Intravenous infusion, Different Drug

therapy, prophylaxis Additional hours
or diagnostic; will be reported
additional sequential using 96366
infusion, up to 1 hour
(list separately in
addition to primary
code)

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Codes Description Time Duration
96368 Intravenous infusion, 16 to 90 minutes
for therapy, Can only be billed
prophylaxis, or ONCE regardless of
diagnostic; concurrent the duration of the
infusion) list concurrent infusion
separately in addition
to primary code) ONCE
per day
96372 Subcutaneous or IM No restrictions on
injection multiple injections
96374 Therapeutic, 15 minutes or less
prophylactic or Do NOT report this
diagnostic injection; with Initial
IVP, single or initial Therapeutic
substance/drug Infusion (96365)
unless meets
criteria
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Codes Description Time Duration
96375 Therapeutic, 15 minutes or less
prophylactic or NEW drug
diagnostic injection;
each additional
sequential IV PUSH of
a NEW substance/drug
(list separately in
addition to code for
primary procedure
96376 Same as Above except 15 minutes or less
SAME drug SAME drug
Must be 30 minutes
since initial push

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 90460 90474

Code only one INITIAL immunization

administration per visit

Follow same rules as injections/infusions

Parentheticals below immunization codes

clearly state which combinations are not
allowed to be billed together

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 IM or Subcutaneous Injections: 96372

Multiple IM/Subcutaneous Injections:

Same drug/substance can be reported as long as it
is ordered and documented
There are no time restrictions/guidelines present at
this time
Documentation needs to be made of site and time

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 Some answers:
Per AMA Infusion time is measured when the
infusate is actually running: pre and post time are
not counted. It is recommended to document
infusion start and stop times.
Per CMS IOM 100-4, Chapter 4, 230 Hospitals are
to report codes according to CPT instructions. CPT
instructions are to use actual time over which the
infusion is administered to the beneficiary for time-
specific drug administration codes.
CMS Indicates that it has the expectation that
hospitals will document time otherwise CMS has a
difficult time understanding how services would be
billed appropriately.
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 Physician and nursing documentation are the
key for accurate charging.

Typically, hospital documentation for infusion

services reflect the substance being infused
and the flow ratebut this is not enough.

Drug administration services that reference

time are in fact time-based codes, therefore
documentation should support the billed
charges.

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 Time Documentation is Critical and Drives the
Accuracy of the Codes Reported:
Less than 15 minutes
More than 15 minutes (16+)
31 minutes to 1 hours
15 to 90 minutes vs more than 90 minutes (91)
30 minutes since the last reported push
Greater than 30 minutes beyond 1 hour increments
(91)

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 The infusion time is defined as the actual
time over which the infusion is administered.
Infusion time is calculated from the time the
administration commences (i.e., the infusion
starts dripping) to when it ends (i.e., the
infusion stops dripping).

Intravenous or intra-arterial push

administration are differentiated from the
other infusion services and defined as
infusion of 15 minutes or less.

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 Billing and Coding for Infusions need:

Name of the Drug

Strength of the Drug
Method of Administration
Time-Time-Time

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 The Rules for Documentation:
Must be ordered by a physician
Documentation must support medical necessity
EACH substance administered is:
Clearly documented, no abbreviations
Route and Site are easily discernible
Start and stop times for EACH substance are
documented
This is the best practice
Amount of EACH substance given is documented

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 Sometimes Its OK to Have More Than One
Initial or Primary Service Code

Separate Site Separate Encounter

2 am

4 pm

To report 2 different initial service

codes use Modifier -59.

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A Concurrent Infusion
occurs when multiple
infusions are provided
simultaneously through
the same intravenous
line.

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 Sequential is one after the other through the
same venous access site.

Concurrent is at the same time through the

same access site (but may be through a
different lumen of the catheter).

Multiple drugs added to one bag of fluids are

NOT a concurrent infusion.

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Hydration is considered an infusion of
prepackaged fluid for the purpose of restoring
bodily fluid. There must be physician
documentation of medical necessity to charge for
hydration. This includes but not limited to:

Dehydration/Volume Depletion
Inability to maintain fluid intake (i.e., nausea &/vomiting)
Sugar &/ electrolyte imbalances
Diarrhea
Pain

*NOTE: Hydration cannot be reported for TKO, KVO, Heplock, Saline Lock

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 Only one initial service code should be reported, unless two
separate IV sites are required;
Hydration codes are reported after 30 minutes of infusion
(31)/Do not charge hydration when provided for 30 minutes or
less;
Concurrent infusion is only reported once per encounter;
Sequential is one after the other; concurrent is at the same time.
In order to report a concurrent administration, the drugs cannot
simply be mixed in one bag; there must be more than one bag;
Infusions of 15 minutes or less are reported with an IV push
code;
Injections are coded per injection, not per medication;
Each additional sequential IV push of the same substance must
be greater than 30 minutes;
Vaccination codes utilize an administration code 90465-90474
in addition to the vaccine/toxoid 90476-90479;

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 Do not charge for hydration and infusion during the same
time interval;
Hydration consists of pre-packaged fluid and electrolytes
(e.g., normal saline, D5 normal saline + 30 mEq KCl/liter);
Do not charge for services integral to a procedure (e.g., drugs
given during CPR or prior to intubation);
Infusion is for the administration of substances/drugs. When
fluids are used to administer the drug(s), the administration
of the fluid is considered incidental hydration and is not
separately reportable;
Hydration is not coded on a concurrent service.

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Contrast Epinephrine Surgery
during during CPR or
CT Scan Recovery

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 If performed to facilitate the infusion or
injection, the following services are included
and are not reported separately:
Use of local anesthesia
Intravenous (IV) start
Access to indwelling IV, subcutaneous catheter or
port
Flush at conclusion of infusion
Standard tubing, syringes and supplies
Preparation of the chemotherapy agent(s)

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To begin, select one column based on the facility
hierarchy whereby infusion is first, IV push is second and
hydration is third. Mark all remaining charges in that
column. If a patient does not receive an IV infusion, start
with the IV push column. If a patient does not receive an
infusion or an IV push, start with the hydration column.

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MEDICATION INFUSION IV PUSH HYDRATION

____96365 Initial Infusion ____96374 Initial Push or ____96360 Initial hydration

up to 1 hour Infusion <16 min up to 1 hour must be at
least 31 min
____# hours 96366 Each ____# 96375 IV Push Each
addl hour (after 31 min) push of different drug ____# hours 96361
Hydration Each addl hour
____# 96367 Sequential ____# 96376 Each IV push (after 31 min)
infusion up to 1 hour (use of same drug at intervals >30
96366 for addl hours of min ____# 96372 IM/SQ
sequential infusion) injection
____# hours 96361
____96368 Concurrent Hydration Must be at least ____90471 IM/SQ vaccine
infusion Report only once 31 minutes
per encounter ____# 90472 Each addl
____# 96372 IM/SQ IM/SQ vaccine
____# 96375 IV Push Each injection
push of different drug
____90471 IM/SQ vaccine
____# 96376 Each IV push
of same drug at intervals >30 ____# 90472 Each addl
min IM/SQ vaccine

____# hours 96361

Hydration Do not charge
during same time of infusion,
must be at least 31 min

____# 96372 IM/SQ

injection
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____90471 IM/SQ vaccine
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Jane Smith comes into the ER with vomiting.
Dr. Roberts orders an IV push of Zofran and IV
hydration for dehydration. The nurse
documents that she administered the IV push at
1:44 p.m. She also documents that she started
the hydration at 2:05 p.m. and discontinued it
at 4:10 p.m. How do you code the
injections/infusions on this case?

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 96374 IVP

96361 x 2 - Hydration

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 A 66-year-old patient arrives to the ER and
receives a therapeutic infusion from 10:15
am to 11:55 a.m. The patient receives an IV
push of the same drug at 1:00 p.m.

How is this reported?

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 96365 1st hour of infusion

96366 2nd hour of infusion

96376 IVP of the same drug

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 A 54-year-old patient comes to the ER
complaining of pain in his legs and back
saying he feels nauseous and lightheaded.
The ER starts an IV and begins hydration from
7-7:25 a.m. and IVP of Morphine is given at
8:00 a.m.

How is this reported?

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 96374 IVP of Morphine

No code is assigned for the hydration since

the time is less than 30 minutes.

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 Patient has the following:
Lasix IVP @ 10:00 a.m.
Lasix IVP @ 10:25 a.m.
Phenergan IVP @ 10:40 a.m.
Lasix IVP @ 1:00 p.m.
Lasix IVP @ 3:00 p.m.

How is this reported?

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 96374 x 1 Initial IVP Lasix
96375 x 1 IVP different drug (Phenergan)
96376 x 2 IVP same drug (Lasix)

NOTE- Lasix IVP at 10:25 cannot be billed

since it had not been 30 minutes since initial
push.

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 Patient presents to the ER in respiratory
failure. Patient was administered an IVP of
Etomidate at 0200 and was intubated. Patient
was placed on a ventilator and maintained
good oxygen saturations. Patients heart rate
dipped to 50 but responded to IVP of
Atropine at 0300. Patient infused with
Vancomycin from 0325-0435. Levaquin
infused from 0345-0420.

How would this be reported?

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 96365 Initial Infusion of Vancomycin

96367 Sequential Infusion of Levaquin

96375 IVP Atropine (different drug)

Etomidate would not be charged since

integral to the intubation.

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