Subcutaneous Infusion Coding for Success

When it comes to subcutaneous infusion services, there are a few key codes worth examining for accurate reporting.  In 2008 the AMA introduced three new CPT^® codes for the subcutaneous infusion of therapeutic or prophylactic substances. This method of administration is more commonly encountered in home infusion therapy services rather than the outpatient hospital setting. By learning the rationale behind the codes, CPT coders can overcome challenges for successful reporting while safeguarding compliance.

Identifying Coding Indicators  

So, what are the indications for these codes? Understand that indications for this mode of administration are based on:

• frequency of administration
• adjustments to dosage
• and fragility of available veins for infusion.

Due to the patient’s clinical presentation, it is assumed that intravenous infusion services will not be billed during the same encounter as a subcutaneous infusion. Note that the coding hierarchy for the determination of primary and secondary services does not include reference to the subcutaneous infusion service.

Primary Distinctions and Need to Know Characteristics

So how does subcutaneous infusion differ from intravenous infusion? The difference is that subcutaneous infusion enables continuous infusion as well as intermittent infusion or bolus administration. Although contingent on what type of drug is being delivered and the type of equipment utilized, this form of administration enables patient control of the dosage. This is commonly seen with insulin for a diabetic patient or when morphine is administered through patient-controlled analgesia (PCA) pumps used in managing pain for example.

What is the main difference between the two infusions? The primary distinction between an intravenous infusion and the subcutaneous infusion is the rate at which the drug or substance may be administered.

The subcutaneous infusion relies on maximum tissue absorption, which is typically 3 cc per hour. Problems can arise with calculation because a lack of consensus exists about converting a standard IV dose to the subcutaneous dose to maintain therapeutic levels.

Note that the code definitions include the setup and establishment of the subcutaneous infusion site. The devices utilized for this technique vary, in that it may be either a needle or soft catheter that is inserted under the skin, with most common placement being the subcutaneous tissue of the arm, thigh, or abdomen. Understand that once placed, the needle or catheter may remain in place for up to two or three days. Available devices range from single-needle to multi-needle options that may connect to a continuous pump or to a “button pump,” which allows for patient-controlled dosing.

So, what are some of the critical characteristics for correct reporting? First, the documentation of start and stop time for the subcutaneous infusion is integral to correct reporting of CPT codes and units of service. Coders should also understand time plays an essential role when it comes to assigning subcutaneous infusion codes. Reviewing all the parenthetical notes after 96369– 96371 in the CPT codebook for further guidance on code selection is another important step to take to ensure accuracy.

Master more everyday challenges and find further educational insights by utilizing our 2022 Coding Essentials for Infusion & Injection Therapy Services.