Ambulatory Coding & Payment Report
Reader Question: IVs in an Ambulatory Setting
Question: Our hospital is using its ambulatory surgery unit to administer IVs other than chemotherapy and blood transfusions. Which UB-92 code is appropriate (360, 490)? Which CPT code should be used for the facility fee (clinic 99211, etc.)? And which CPT codes are appropriate for the infusion therapy (Q0081) and/or blood transfusions (36430)?
New Mexico Subscriber
New Mexico Subscriber
Answer: The facility fee should be based on your revenue code and depends on such factors as the amount of physician involvement and the time spent on the procedure. CPT 99211 (office or other outpatient visit for the evaluation of an established patient, that may not require the presence of a physician ...) should be reported for a visit when the presenting problem is minimal, takes about five minutes to perform, and does not require the presence of a physician. Such may be the case for a course of chemotherapy, for instance, provided the physician has no contact with the patient.
If a patient comes to the facility for the sole purpose of having an IV infusion, no E/M service can be billed. Use the appropriate injection and administration code. However, if complications associated with transfusions occur and the physician becomes involved in treatment, the physicians services may be covered. Code 99211 should not be used to describe a visit for the sole purpose of receiving a routine injection, however.
As for infusion of Medicare patients, Q0081 (infusion therapy, using other than chemotherapeutic drugs, per visit) is appropriate for anything other than chemotherapeutic agents. Blood transfusions, on the other hand, need two codes for correct billing: Report 36430 (transfusion, blood or blood components) for the administration, and it should be accompanied by the level-two HCPCS code for the blood product infused.
Check with your blood bank to see if this is entered into the bill from the blood bank or hard-coded from the chargemaster.
For the UB-92, 360 (operating room services/general) is more appropriate than 490, which indicates ambulatory surgical care not covered by any other category.
- Published on 2001-09-01
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