Much more than a coding resource: A guide to full, compliant payment
Don’t let critical documentation gaps or coding mistakes hinder your reimbursement and compliance. Our Coding Essentials for Infusion & Injection Therapy Services equips you with the knowledge and tools to navigate the challenges and ensure maximum payment for these essential services.
Starting with clear authoritative guidance from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS), supplemented by plain-English explanations, quick tips, answers to FAQs, case examples and other tools, the Coding Essentials for Infusion and Injection Therapy Services helps you capture — and keep — the full, compliant payment for these high-volume services.
Key Features and Benefits:
- Complete coverage of changes related to infusion and injection therapy services.
- Guidance on implementing and coordinating mid-year changes seamlessly.
- Proven tactics to prevent high-risk practices and minimize auditor takebacks.
- Step-by-step instruction on coding hierarchies and addressing payer challenges in drug administration and other infusion services.
- COVID-19 documentation requirements and therapeutic infusion and injection coding.
Expertly Addressed Questions and Concerns:
- Comprehensive documentation guidance for timed codes, including start and stop times, routes, sites, and flushes.
- Requirements and modifiers for “white bagging” and “brown bagging” drug supplies.
- Impact of smart pumps and other technologies on documentation.
- Detailed understanding of Comprehensive APC (C-APC) for observation care.
- Coding and billing strategies aligned with Medicare’s shift to site-neutral payments.
Clear and Practical Guidance for Daily Tasks:
- Coding and documentation guidance for infusion and injection services in all care settings.
- In-depth coverage of various infusion and injection services, including hydration therapy, drug administration, injections, chemotherapy, blood collection, transfusions, and more.
- Quick-reference coding index for easy lookup of drug administration codes.
- Easy-to-understand overviews of coding systems, modifiers, E&M services, medical necessity, coverage determinations, audit targets, and critical topics.
- Detailed service descriptions, intended code use, documentation requirements, time reporting tables (where applicable), drug examples, and billing tips.
- Case studies, FAQs, and examples to reinforce best practices and address common challenges.
- Chapter with payment tables for physicians and hospitals.
With our comprehensive guide, you can confidently navigate the coding, documentation, and billing complexities of infusion and injection services, ensuring full payment and compliance.
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Section 1: Fundamentals
Introduction
- Scope
- Promoting Financial Excellence
- Organization of This Book
Chapter 1: Medicare Payment Primer
- Coding Systems
- Place of Service
- Appropriate Use of Modifiers
- Claims Processing
- Reasonable and Necessary Services
- Not Reasonable and Necessary
- Medicare Recovery Audit Program
Chapter 2: Clinical Background
- Infusion Types
- Documentation Requirements
Chapter 3: Business Processes and Operations
- Elements of the Data Flow
- Evaluating the Data Flow Process
Chapter 4: Charge Reconciliation and Auditing
- Charge Reconciliation
- Auditing
- Charge Capture Solutions
- Process and Procedure Tips
Section 2: Hydration
Chapter 5: Hydration Therapy
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Fluids
- Case Study Claims: Hydration
Section 3: Drug Administration
Chapter 6: Intravenous Infusion
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
- Case Study Claims—IV Infusion
Chapter 7: Subcutaneous Infusions
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
Chapter 8: Injections: Intravenous
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
- Case Study Claim: IV Push in the Emergency Department
Chapter 9: Injections: Subcutaneous, Intramuscular, or Intra-arterial
- CPT/HCPCS Codes
- Intended Use
- Subcutaneous On-Body Injector
- Billing Tips
- Drugs
- Case Study Claim: IM/SQ Injection
Section 4: Chemotherapy
Chapter 10: Chemotherapy: Injections
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
- Case Study Claim: Intramuscular Injection of Chemotherapy
Chapter 11: Chemotherapy: Intravenous Push
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
- Case Study Claim: Chemotherapy IVP
Chapter 12: Chemotherapy: Intravenous Infusion
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
- Case Study Claim: Chemotherapy IV
Chapter 13: Chemotherapy: Other Modes of Administration
- CPT/HCPCS Codes
- Intended Use
- Bundled Procedure
- Billing Tips
- Case Study: Intraperitoneal Chemotherapy
Chapter 14: Other Infusion Services: Implantable and Portable Drug Delivery Systems
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
- Drugs
- Case Study
Section 5: Other Procedures
Chapter 15: Blood Collection
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
Chapter 16: Transfusion of Blood and Blood Components
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
Chapter 17: Therapeutic Pheresis
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
Chapter 18: Declotting Vascular Access Device
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
Chapter 19: Vaccines and Toxoids
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
Chapter 20: Therapeutic Phlebotomy
- CPT/HCPCS Codes
- Intended Use
- Billing Tips
Section 6: Pharmacy
Chapter 21: Coding for Drugs and Biologicals
- Level II HCPCS Codes: Usage and Format
- Revenue Codes
- Documentation for Drugs and Biologicals
- Documentation of Medical Necessity
- Drugs Furnished “Incident to” a Physician’s Service
- Coverage and Coding Self-Administered Drugs
- White and Brown Bagging Medications
- Drugs Billed as Supplies
- Billing Tips
Section 7: Observation
Chapter 22: Observation Accounts
- Drug Administration Coding
- Drug Administration Charge Capture
- Billing Tips
Section 8: Frequently Asked Questions
Chapter 23: Frequently Asked Questions
Appendices
Appendix A: Correct Coding Edits for Hospital Outpatient Infusion Services
Appendix B: Correct Coding Edits for Practitioner Infusion Services
Appendix C: Avoiding Drug Name Confusion
Appendix D: Avoiding Error-Prone Drug Documentation
Appendix E: Coding for Drugs and Biologicals
Appendix F: Local Coverage Determination for Drugs and Biologicals
Appendix G: Table of Drugs
Appendix H: COVID-19 Vaccine and Infusions Coding Guidance
