Q&A: Charging separately for multiple IV pushes
Q: If a provider documents multiple intravenous (IV) pushes with the same time stamp, can we charge them separately?
A: The short answer is yes. You have separate orders for separate IV pushes and the pushes are separately given, so the drugs are not combined. It’s possible you may have a couple of drugs that are given with the same start time because IV pushes are given quickly. There’s nothing to say that because they are given one after another, but with the same time, that you can’t charge each separately. Remember to follow the CPT drug administration coding hierarchy rules.
According to the guidelines under “Hydration, Therapeutic, Prophylactic, Diagnostic, Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration” in the 2018 CPT Manual:
When these codes are reported by the facility, the following instructions apply. The initial code should be selected using a hierarchy whereby chemotherapy 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 is to be followed by facilities and supersedes parenthetical instructions for add-on codes that suggest an add-on of a higher hierarchical position may be reported in conjunction with a base code of a lower position.
Facilities must also follow CMS’ guidance as outlined in the Medicare Claims Processing Manual.
Editor’s Note: Jugna Shah, MPH, president and founder of Nimitt Consulting, and Valerie A. Rinkle, MPA, lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp®, answered this question during the HCPro webinar, “2018 Injections and Infusions Coding: CMS’ New Packaging Policies and Reimbursement Implications.”
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