1. 2010 UBO/UBU Conference Title: Common Coding Errors in IV Services Session: W-5-1530

2. 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

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

4. “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 4

5. “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) 5

6. “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 6

7. 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

8. 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

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

10. “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

11. “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 11

12. Scenarios of Common Coding Errors 12

13. Initial Services Coding Errors 13 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)

14. Correct coding: 96365 (Intravenous infusion, therapeutic) – IV antibiotics 96375 (each additional push) – Toradol IVP 14

15. 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. 15

16. Correct coding: 96374 (Initial push) – Zofran IVP 96375 (each additional push) – Toradol IVP 96361 (additional hydration) – normal saline 16

17. 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 17

18. Correct coding: 96374 (initial IV push) – Phenergan IVP @ 1100 96375 (each additional push) – Zofran IVP @ 1109 96376 (IV push, same drug) Phenergan IVP @ 1240 18

19. 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 19

20. Correct coding: 96374 (Initial push) 20

21. 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. 21

22. 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) 22

23. Questions: 23

24. References 2010 AMA CPT Manual, Professional Edition Coding Clinic for HCPCS - First Quarter 2009 Page: 6-8 MHS Coding Guidelines 5.10. 24