At first look, the CPT® 2012 manual appears to present a completely revamped set of infusion administration guidelines. However if you're confused about what exactly is new, you aren't alone. This expert medical coding insight will give you a rundown on these guidelines and related CPT codes.
Good news: The guideline revisions fall more under the category of "clarification" than under the category of "change". For instance, it offers clarified language about when hydration can be billed and how dates of service in an overnight outpatient hospital stay for observation must be reported. Thus the 2012 guidelines bring better direction supporting what practices must have been doing all along.
Watch for Supported Office/Outpatient E/M Visit
The revised guidelines add details on which E/M codes you may report in addition to the infusion administration CPT codes.
From the 2011 guidelines, you by now know that your physician may report an important, distinctly identifiable E/M service in addition to the infusion service code by appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.
The 2012 guidelines go a step further by affirming in case a separately identifiable E/M is executed, you must report a distinct "office or other outpatient" E/M service. To emphasize the point further, the guidelines list the possible office/outpatient CPT codes:
In a distinctive case, a physician reporting an E/M plus infusion admin for the same patient will be carrying out both in the office setting. This is for the reason that physicians should not submit claims for most infusions performed in a facility. As the guidelines state, infusion admin CPT codes 96360-96379, 96402, 96409-96425, 96521-96523 are not aimed to be reported by the physician in the facility setting.
Review When 2 Initial Codes Are OK
The 2012 guidelines go into more detail than the 2011 guidelines did on the meanings of initial, sequential, and concurrent when used in the infusion code definitions. The guidelines also propose practical information on how to apply the CPT codes.
Similar to the 2011 guidelines, the 2012 CPT guidelines state that while administering multiple infusions, you must report only one "initial" service CPT code. (CPT® 2012 adds "for a given date.") The exception under both 2011 and 2012 guidelines is that you may report more than one initial CPT code if protocol needs use of two distinct IV sites.
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