HII CODING PROCESS

Introduction:

➢ The IV drug administration CPT codes are grouped into three categories: These categories are 1. Hydration 2.
Therapeutic, prophylactic or diagnostic 3. chemotherapy.
➢ Add-on codes are used to report additional sequential and concurrent services.
➢ Should never report a drug administration charge for the administration of contrast, KVO (keep vein open) or
flushing related to an infusion or injection.
➢ CMS has clarified that drug administration services during, prior to or following a procedure should not be
billed separately if they are related to a procedure regardless of whether they are the standard of care for the
procedure.
➢ Injection and infusion documentation should include the drug or fluid administered and the quantity given.
The method, the site, and time of administration should be clearly documented.
➢ When multiple medications are documented with the same administration time (and there is no other
documentation to the contrary), it must be assumed the medications were administered together. A single
drug administration HCPCS/CPT code is reported.

IV Drug Administration Categories:

There are three categories of IV drug administration services. These categories each have their own HCPCS/CPT
codes which are based on the type of product or substance administered.

➢ Hydration (96360 and 96361)

➢ Chemotherapy- We are not coding
➢ Therapeutic, Prophylactic, and Diagnostic services
o Infusion- 96365-96368
o Injection (IV Push)-96374-96376
o Intramuscular (IM)/Subcutaneous (SQ) -96372
o Vaccination-90471&90472

Hydration:

➢ Hydration Service CPT codes are reported when an IV infusion is performed to administer pre-packaged fluids
and/or electrolyte solutions such as normal saline or D5 ½ into the body for treatment.
➢ CPT code 96360 is reported for the documented initial hydration infusion, with a documented infusion time of
at least 31 minutes.
➢ In addition to reporting CPT code 96360 for the first hour, CPT code 96361 is an add-on code and is used to
report each additional hour that the hydration infusion extends greater than 30 minutes past the prior hour.
➢ When administering hydration IV infusions, it is very important to note that if an IV infusion is administered
for 30 minutes or less, those hydration services ARE NOT billable. Therapeutic, Prophylactic, and Diagnostic
services (Non-Chemotherapy):
➢ These CPT codes are used to describe IV drug administration of any substance or drug product other than pre-
packaged fluids and/or electrolytes and substances considered chemotherapy.
➢ These CPT codes are used to report IV drug administration provided for therapeutic purposes to heal or treat a
condition, prophylactic purposes to protect or prevent a condition, and diagnostic purposes to identify a
condition.
Therapeutic/prophylactic/diagnostic injection and infusion:

➢ Infusion:
It involves the administration of IV fluids and/or drugs over a period for diagnostic or therapeutic purposes.
➢ IV push & IM/SQ:
Delivers a dosage in one ‘shot,’ either very quickly or in some cases over a period where the healthcare
provider is continuously present to administer the injection either subcutaneously, intramuscularly, intra-
arterially, or intravenously.

➢ Vaccination:
90471 One vaccine, single or combination vaccine/toxoid. Immunization administration (includes
percutaneous, intradermal, subcutaneous or intramuscular injections). 90472 Each additional vaccine, single
or combination vaccine/toxoid. (List separately in addition to code for primary procedure.)

Hierarchy for IV medications Rules:

CODE Rules to apply charge Route

Hierarchy for IV medications

Top ***** USE FOR MEDICATION INFUSIONS ONLY*****
96365 INITIAL IV INFUSION - First hour -MINIMUM 16 MINUTES IV
96366 ADDITIONAL HOUR(S) GREATER THAN 31 MINUTES IV
96367 Sequential Infusion MIN 16 MINUTES - (INFUSED BEFORE OR AFTER ANOTHER INFUSION) IV
96368 Concurrent Infusion MIN 16 MINUTES- (ADDED DURING ANOTHER INFUSION) IV
******Use for IV Injections******
96374 IV PUSH/INJECTION- CANNOT BE CHARGED WITH (96365-96368) OR 96360 IV
Sequential IVP- New Medication administered at a different time (MIN 1 MINUTE FROM
96375 OTHERS) IV
Sequential IVP of a previously administered Medication (MIN of 31 Minutes from previous
96376 administration) IV
Bottom ************* USE FOR HYDRATION INFUSIONS*************
96360 MINIMUM OF 31 MINUTES AND NO OTHER IV SUBSTANCE ADMINISTERD DURING VISIT IV
96361 MINIMUM OF 31 MINUTES-( SEE GRID FOR EXTRA HOURS CALCULATION) (starting with 91 IV
minutes)- DO NOT CAPTURE ANY TIME FLUIDS ARE RUNNING AT THE SAME TIME AS
ANOTHER INFUSION OF MEDICATION IV

Route
TO CHARGE MULTIPLE UNITS MEDICATION MUST BE GIVEN AT A DIFFERENT TIME OR IN A IM or
96372 DIFFERENT AREA (I.E LEFT ARM/RIGHT ARM LEFT GLUTE/RIGHT ARM ETC) Sub Q

VACCINATION ADMINISTRATION
90471 USE FOR INITIAL VACCINATION (IMMUNIZATION) (AKA TETANUS OR RABIES VACCINE)
90472 USE FOR ADDT*L VACCINATIONS (IMMUNIZATION) - DIFFERENT TIME OR SITE

SPECIAL NOTE FOR immunoglobulin’s

96372 USE FOR IMMUNOGLOBULINS (e.g. Rabies Immunoglobulin or Rho Gam)

Note: Codes in yellow are called "PRIMARY CODES" - There can only be one primary code
per encounter. Therapeutic infusions (i.e. medication) will ALWAYS be primary to any
other codes (Must have start/stop in order to capture infusions)
Important points to remember:

➢ Only one initial code must be coded among IVPB, IVP and Hydration. i.e. 96365, 96374 and 96360 should
never be coded together if only one IV line is present.
➢ If IVs are given at two different sites, we need to cross verify in ED records C/ Nurse note. If two different
saline locks are placed only, we must give two initial codes, if not consider this as one IV site and assign
only one initial code.
➢ If vaccines are administered in ED, check clearly whether the drug administered is Vaccine or
Immunoglobulin (Ig), because Vaccine should be coded as 90471/ 90472 and Immunoglobulin should be
coded as 96372.
➢ If drug A and drug B are given at 10:00 and both are repeated at 11:00 we should code 96374 and 96376
(since both drugs are repeated).
➢ If drug A and drug B are given at 10:00 and drug A and drug C are given at 11:00, we should code 96374
and 96375 (since new drug is administered along with repeated drug, we must code new drug as per
hierarchy).
➢ To code 96376, we need minimum of 31 minutes’ time difference compulsorily.
➢ If any therapeutic drug is given as infusion and stop time is not documented, code it as IVP and consider
as infusion for level of 99284.
➢ If there is no stop time documented for hydration like NS, NACL, D5%, do not code any CPT but consider
this for Level of 99284.
➢ To code Concurrent CPT 96368 is only one time per visit.