Are You Struggling with Drug Administration in 2007?

(PYA Alert dated April 6, 2007)

Major changes were implemented in 2007 for coding and billing of drug injections and infusions. Key to these changes, we have reverted to reporting of drug administration charges through CPT codes.

• Do the right people across your organization understand the impact of these changes?
• Has education been provided to pertinent clinical staff?
• Have the chargemaster, encounter forms, and charge tickets been appropriately modified to reflect full use of CPT codes?

The AMA confirms that only one initial service code may be reported, in accordance with an established CPT hierarchy for selecting the primary or initial service. Secondary services for drug administration are reported as “subsequent/sequential”, “concurrent,” and “each additional”. Subsequent and/or sequential infusion refers to a drug/substance administered before or after the initial service code. Concurrent infusions are reported with a unit of “one” regardless of the duration of the infusion. Staff familiarity with these concepts will facilitate correct reporting of services to receive appropriate reimbursement.

Also among changes, the previous eight-hour limit for the number of hours reported using “additional hour” infusion codes has been eliminated. Most importantly, CMS reimburses separately for each additional hour of infusion, so clear documentation of start/stop times is critical to appropriate charge capture and reimbursement.

PYA’s team of Clinical Compliance and Reimbursement professionals can lend support in assessing your compliance and reimbursement risks, targeting process improvement opportunities, and educating your staff to ensure your organization’s compliance with recent changes to Drug Administration reimbursement.

Please contact Carol Eyer at (800) 270-9629

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

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