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Charging for infusions that run overnight at facility

Gloria Posted Thu 12th of July, 2018 15:03:25 PM
Are infusions that run continuously from one date to another charged on the first day only? I have 2 scenarios for 2 different encounters that I would like clarification on. First one is, observation patient had a Saline Infusion ran for 55 hours and 15 minutes. It started on 07/03/18 at 23:45 and ran until 07:00 on 07/06. It was the only infusion. How would I charge for that? My second question is on another observation patient who had Diltiazem infused for 12 hours and 21 minutes on 06/18 to 06/19. It started at 18:39 and stopped at 07:00 the following morning. How would I charge for that?
SuperCoder Answered Fri 13th of July, 2018 07:33:30 AM

Hi,

The hydration performed continuously over days is treated as one encounter or episode. Hence, the correct infusion codes for the above scenarios are :

First scenario : 96360 * 1

                        96361 * 8 (maximum MUE/ day 8)

Second scenario : 96365 * 1

                              96366 * 8 (maximum MUE/ day 8)

Further query is welcome.

Gloria Posted Tue 17th of July, 2018 13:49:10 PM
Hello, Thank you for your response. We wouldn't need to charge for the portions given on that specific day? Meaning in the first scenario the infusion didn't start till 23:45 on 7/3 so wouldn't it need to run at least 31 minutes to charge for that day?
SuperCoder Answered Wed 18th of July, 2018 02:55:29 AM

Hi Gloria,

As per the CMS guidelines, Infusion/Hydration codes are time based codes, in addition to being time based, the time frame is of chief importance (the time for which the patient recives therapy). Also, the above documentation states the define time frame and is continous, hence the mention of the portions is not applicable.

Hope this helps!

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