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BILLING BASICS: Got Infusion Coding Questions? We've Got Answers

Experts provide quick help with 90780, 90781

If you're not sure what to do when a patient's infusion therapy lasts longer than eight hours, you've got company. Check out this handy Q-and-A session to navigate the finer points of timing.
Question: If an infusion exceeds eight hours, how should I report the service?
Answer: The general rule is to report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for the initial hour and +90781 (... each additional hour, up to 8 hours) for each subsequent hour - but only until the beginning of the ninth hour.
However, since you are expending additional resources for additional hours of infusion, you may report the hours exceeding eight, but confirm with your fiscal intermediary (FI) before doing so, and make sure your documentation supports it. You will, of course, only get paid once for ambulatory payment classification (APC) 116, but it is important to bill for the extra hours for statistical accuracy, says Barbara Love, CPC, CPC-H, CMBS, compliance analyst and educator for the University of Rochester Medical Center in Rochester, N.Y. "For future decisions by CMS, we should report all hours infused," Love says.
For example, suppose the physician administered infusion therapy to a patient for 13 hours. You would report the service with 90780 for the first hour, and 90781 x 12 for the remaining hours, Love says.
Remember: Code 90780 is a per-visit code, and 90781 is bundled, Love says.
Question: Where can I find the guidelines for billing 90780 and 90781?
Answer: The guidelines are available online at the Federal Register. To view them in full, visit , pages 65812 through 65814.
You can also find them in the Code of Federal Regulations, chapter 42 CFR, part 419.
Question: We only receive one payment for APC 116, no matter how many hours the patient receives infusion. But what if the patient presents twice in a day and requires infusion both times?
Answer: In such a case, you could report 90780 more than once - and get paid for it. For this situation, you would append modifier -59 (Distinct procedural service) to 90780 to describe the second and subsequent visits. You can receive reimbursement for up to four visits per day.

Question: Why should I bill Medicare for more than eight hours of infusion, when I know they're not going to pay?
Answer: For starters, to be compliant you must charge all insurers equally for the same services, says Merrilee Kaulitz, outpatient coder at Watertown Hospital in Watertown, Wis. Therefore, regardless of whether government or commercial insurers [...]

- Published on 2005-02-12