Refresh Your Injection and Infusion Hospital Coding and Billing Knowledge

A Review of the CPT Coding Hierarchy, Including How to Report Initial, Sequential, and Concurrent Services

Presenter - Jugna Shah

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Disclaimer The information disseminated in today’s seminar, whether oral or written, is

intended to offer the user with guidance. This information is not intended to replace or serve as substitute for any compliance advice, consultation or service. You should consult further with a professional if you have specific areas of compliance concern.

This information is provided without any warranties, express or implied, and is only accurate and timely as of June 30th when it was prepared based on all publicly available and official information.

In no event shall Nimitt Consulting or its employees be liable for any direct, indirect, or incidental actions that may result from the use of this information. If there are questions about any of the information presented, we recommend you consult directly with CMS or your MAC.

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Agenda

Part I: Intro and True/False Quiz to Test Your Knowledge

Part II: Review and Refresh Drug Administration Rules and Key Concepts

Part III: Frequently Asked Questions

Part IV: Clinical Scenarios

Summary and Final Q/A (or frequently asked questions)

Timeline of drug administration coding(Q-codes vs. CPT codes vs. G-codes vs. new CPT codes)

Year 2000-2004 2005 2006 2007 2008

Hospital-OPPS

Generic Q-Codes (Q0081, Q0083,

etc.)

CPT Codes (90760, 90784,

etc.)

C-codes & CPT Codes in Combination

New CPT codes, concepts,

descriptions w/implied hierarchy

Same as 2007 w/formal reference

to hierarchy

Physician-MPFSCPT Codes (90760,

90784, etc.)

G-Codes - temporary during CPT

code development

New CPT codes,

concepts, & descriptions No Changes No Changes

Year 2009 2010 2011-2012 2013 2014

Hospital-OPPS

Code numbers change, but rules

do not

Codes & rules did not change,

some text added

Minor changes to codes and some new text added

Codes & rules did not change,

some text addedCodes & rules did not change, some

text added

Physician-MPFS

Code numbers change, but rules

do not No Changes No Changes No Changes No Changes

Some Reasons for the Challenges Hospitals Face in Reporting Injection and Infusion Services

Terms and concepts not intuitive for hospital use Initial/primary service Sequential/subsequent/concurrent Scheduled vs. unscheduled patients Patients crossing departments Lack of applicability of all CPT rules for hospital reporting

Questions continue What constitutes appropriate documentation? Are start and stop times required? Can multiple initial services be reported? What happens when the visit/encounter crosses the midnight hour? Is the add-on code, 96366 intended to report multiple different things? Should services be charge driven by nursing or coded by HIM staff?

Staff turnover and conflicting answers to open questions

Part I: Test Your Drug Administration Knowledge

Tips for answering the quiz

Answer the questions from a hospital/facility perspective

Base your answers on official guidance and rulesCPTCMS Your MAC’s guidanceAHA HCPCS Coding ClinicCurrent CCI Manual Instructions

Be able to back up your answers

To see the complete presentation check the below link:

http://www.audioeducator.com/medical-coding-billing/cpt-coding-07-10-14.html