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You Be the Expert: Piggybacking Meds by IV

Test your knowledge.  Determine what you would do in this situation before looking at the box below for the answer.

Question: How do I report the administration of a piggyback medication? From what I can determine, there are several different interpretations among the hospital communities between IV infusion (Q0081) and IV injection (90784). For example, if an antibiotic is administered in an emergency department in a 100cc bag of solution, should this be reported as infusion therapy or as an IV injection? Is the distinction between IV injection and IV infusion the mode of delivering the drug? If several drugs are given IV piggyback in the ED, can we charge for several IV injections or are we limited to charging the IV infusion once?

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Answer: HCPCS code Q0081 (infusion therapy, using other than chemotherapeutic drugs, per visit) is related to the institution of the IV access as well as the solution used. Under APCs, the administration of the fluid itself, i.e., saline or Ringer lactate, without any additional drug, qualifies as an infusion, Q0081. However, if you hang a bag of saline and piggyback in some morphine, you must use both Q0081 and 90784 (therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous). This would be the case in your example of an antibiotic administered in a 100 cc bag of solution.
 
"CPT 90784 addresses payment for the drug administered and the labor related to the administration," says Mason A. Smith, MD, FACEP, CEO of Lynx Medical Systems in Bellevue, Wash. "It is illogical to eliminate the payment for the piggyback administration while paying for the IV push administration of the same drug. This is very straightforward."
 
The definition of Q0081 specifies "per visit," which means the provider may only bill one unit irrespective of the number of IV sites or the number of sticks it took to establish IV access during the outpatient visit. There is no such restriction on 90784, and the outpatient code editor will accept multiple uses of the code and pay for them. Therefore each time you inject another drug into the IV or through the heplock, you have an additional use of 90784. In such cases, make sure to use a multiplier to describe the various uses. These payments should be made as long as the codes are submitted correctly.


- Published on 2001-09-01