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More details on infusion drugs and admin codes please

Selina Posted Tue 09th of October, 2018 20:09:30 PM
Hello, I received your Entyvio article last week and found this question and answer on your site: Could you please explain the different admin codes for different biologic infusion J codes and also where to find the details to share with our staff? (or links to references). Thank you so much!
Selina Posted Tue 09th of October, 2018 20:31:40 PM
Also, are the fluid included in the 1st hour of infusion? If so, please send references for this as well so I can send out to our staff. Thank you!
SuperCoder Answered Wed 10th of October, 2018 03:28:57 AM

Hello Selina,

Thank you for your question.

For infusion and injection administration, the physician order should include all the documentation of the drug name, dosage and the reason for the administration.


Infusion codes are time, route of administration and site-based codes. The documentation should clearly indicate the route of administration and for how long the drug was administered intravenously (duration of IV infusion). The good documentation includes the start and stop time of IV infusion. But it should not be assumed the infusion time based on a physician’s order alone as there is always the possibility that the infusion had to be stopped or discontinued.


Hydration is administered only by intravenous (IV) infusion and is used to report the administration of prepackaged fluids and electrolytes (for e.g., normal saline), not drugs or other substances. A minimum of 31 minutes is required to report the first hour of hydration.


Hydration is bundled when performed concurrently with other infusion services; however, hydration may be reported if provided secondary or subsequent to a different initial service administered through the same IV access. Hydration may also be billed separately if provided prior to the primary substance.


CPT® codes 96360-96379 describe hydration and therapeutic or diagnostic injections and infusions of nonchemotherapeutic drugs. 

CPT® codes 96401-96549 describe administration of chemotherapy or other highly complex drug or biologic agents.

CPT® codes 96413-96417 (Chemotherapy administration, intravenous infusion technique)


CPT® codes 96360, 96365, 96374, 96409, and 96413 describe “initial” service codes.  For a patient encounter only one “initial” service code may be reported unless it is medically reasonable and necessary that the drug or substance administrations occur at separate intravenous access sites. To report two different “initial” service codes use NCCI-associated modifiers.


For more clarity on infusion coding kindly go through the below provided link.

Hope this helps.

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