DESTIN, FLA. — With proper coding in place, billing for in-office infusion procedures can be as simple as billing for an office visit, Reuben A. Allen said at the annual Rheumatology on the Beach.
Infusion coding typically involves infusion procedure codes and drug codes for primary and secondary drugs, and can also include office visit codes, said Mr. Allen, a certified health care compliance consultant and certified management consultant who has a consulting practice in Wilmington, N.C.
Infusion coding is further broken down into complex, diagnostic, and hydration infusion procedures, with primary and secondary coding for each category. For example, with complex infusions, the primary code (96413) is used for the first hour. This code can be used for any complex infusion that exceeds 15 minutes. For each additional hour of infusion, physicians should use code 96415, keeping in mind that this code applies only to an infusion lasting at least 31 minutes following the initial or prior hour, thus it would only be used after 91 minutes of infusion, Mr. Allen noted. The first hour of diagnostic infusion procedures should be coded as 90765, and subsequent hours (the 31-minute rule applies here, as well) are coded as 90766. Hydration infusion codes (90760 for the first hour, and 90761 for subsequent hours) follow the same rules.
Code a first drug pushed as 90774, and each sequential drug pushed as 90775. The correct way to code methotrexate and diagnostic drugs is as subcutaneous or injection drugs. Only one primary code can be used per visit, he said. To code for office visits, there must be a reason for the visit. Billing for an office visit with every infusion will serve as a red flag. When warranted, it is appropriate to use Modifier 25 for the separate and distinct office visit service, keeping in mind that the diagnosis may be different for that than for the infusion.