2010 UBO/UBU Conference Title: Common Coding Errors in IV Services Session: W

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 2

Hierarchy Basics….. Hierarchy Chemo Infusion/Injection Therapeutic Infusion/Injection Pushes Hydration 3

“Initial” Group Each group has at least one initial service code: – Initial Chemotherapy infusion (16 min up to 1 hr) – Initial Chemotherapy injection – Initial Therapeutic Infusion (16 min up to 90 min) – Initial Therapeutic Push – Initial Hydration (31 min up to 90 min) *Initial or first hour of infusion (therapeutic infusions) is from 16 to 90 minutes 4

“Additional Service w/ New Substance” Group Additional infusions/injection of a new substance will be coded with sequential (or concurrent)codes: – sequential chemotherapy infusion (16 min up to 90 min) – sequential chemotherapy injection – sequential therapeutic infusion 96367(16 min up to 90 min) – sequential therapeutic push – sequential hydration (31 min up to 90 min) 5

“Additional Time” Group Add-on codes for infusions that run greater than 30 min beyond 1 hour increments: – each additional hour of chemo infusion – each additional hour of therapeutic infusion – each additional hour of hydration Additional hours of infusion (therapeutic infusions) only after more than 30 min have passed from the end of the previously reported hour 6

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! 7

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 8

Subsequent vs. Concurrent Subsequent – comes after another service Concurrent – happens at the same time as another service 9

“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) 10

“Included and Not Reported Separately” Coding Errors The catheter placement is not coded in addition to the IV services such as chemotherapy, therapeutic and hydration Irrigation of implanted venous access device (aka “flush”) – is not reported if another service is provided on the same day 11

Scenarios of Common Coding Errors 12

Initial Services Coding Errors 13 Scenario 1: Pt with bronchitis given IV antibiotic from 1010 to Dr. ordered Toradol to be given IVP. Pt given IVP Toradol. Pt tolerated well. Line dc’d and pt discharged with instructions. Incorrectly coded: for the IV antibiotic for the IVP Toradol (Both codes are “initial codes” – making them incorrect to report)

Correct coding: (Intravenous infusion, therapeutic) – IV antibiotics (each additional push) – Toradol IVP 14

Initial Services Coding Errors… Scenario 2: Pt with nausea and vomiting x 2days. Hydration of normal saline started Zofran IVP ordered and Toradol IVP ordered and Normal saline Incorrectly coded: 96360, for the IV hydration 96374, for the IVP services. 15

Correct coding: (Initial push) – Zofran IVP (each additional push) – Toradol IVP (additional hydration) – normal saline 16

When Time Becomes A Coding Issue Scenario 3: Pt given the following – Phenergan 1100 Zofran 1109 Phenergen 1240 Incorrectly coded: only reported IVP and IVP 17

Correct coding: (initial IV push) – Phenergan (each additional push) – Zofran (IV push, same drug) Phenergan

When Time Becomes A Coding Issue Scenario 4: 25yr old with bronchitis. IV antibiotics ordered by physician. Started 1300, pt resting. Pt 1415 with orders to f/u prn if symptoms return. Incorrectly coded: (Intravenous infusion, therapeutic) - IV antibiotics 19

Correct coding: (Initial push) 20

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 0830 thru pt’s PICC line. Pt given Zantac and Colace Carboplatin infusion started at 0915 and stopped at Taxol infusion started at 1415 and stopped at Line dc’d from pt’s PICC at PICC line flushed with 10cc ns. Pt tolerated procedure well. 21

Incorrectly coded: (initial chemo infusion, up to 1hr) carboplatin (each additional hour chemo infusion)carboplatin (each additional sequential infusion, different drug) Taxol (additional hydration) normal saline (irrigation of implanted venous device) PICC Line Correct coding: (initial chemo infusion, up to 1hr) (each additional hour chemo infusion) (each additional sequential infusion, different drug) 22

Questions: 23

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