The Centers for Medicare & Medicaid Services (CMS) made permanent changes to the drug administration codes that went into effect earlier this month. Previously, clinicians could only use chemotherapy administration codes when using anti-neoplastic to treat cancer. With the new codes, rheumatology practices are now able to use the same codes as oncologists and bill for monoclonal antibodies, biologic response modifiers and other chemotherapy agents used to treat autoimmune diseases with non-cancer diagnoses.



The new codes for drug administration were billed under temporary G-codes in 2005 as these codes where only applicable on an interim basis. However, the AMA has regrouped the chemotherapy section in the 2006 CPT manual. Approved by the CPT Editorial Panel, the relevant CPT drug administration codes, which apply to rheumatology, are grouped in the following three categories.
• Hydration: 90760 and 90761 (G0345 and G0346)
• Therapeutic or diagnostic injections and intravenous infusions other than hydration: 90765 to 90775 (G0347 to G0354)
• Chemotherapy administration: 96401, 96413 and 96415 (G0359 and G0360)

Nurse practitioners (NPs) and physician assistants (PAs) should be aware of one important coding distinction when billing for drug administration. There are separate codes for “initial” infusion and “additional sequential” infusions. These new codes also identify “initial” and “sequential” for non-chemotherapy intravenous pushes and intravenous chemotherapy pushes for additional drugs.

The term “initial” is included in the codes because Medicare will provide separate payments for each drug one administers on the same day. The term “initial” refers to the first code within a family of codes. At any given patient encounter, clinicians can only bill one “initial” code. When administering multiple drugs, NPs and PAs should use the “additional sequential” codes even if they are from a different family of codes. The “additional sequential” codes are intended to recognize the additional work that an NP or PA performs and the practice expense associated with providing multiple drugs. Therefore, if an NP or PA administers three agents in the same session, one would report one “initial” code and two “additional sequential” drug codes.

What You Should Know
About The Hydration Codes

The codes for billing hydration are 90760 and 90761. Clinicians would use these codes to report hydration IV infusions that usually involve a pre-packaged fluid (e.g., normal saline). However, one should not use the hydration codes in reporting the infusion of drugs or other substances.

The AMA defines these hydration codes as follows:
• 90760: Intravenous infusion, hydration; initial, up to one hour
• +90761: each additional hour, up to eight hours (list separately in addition to the code for the primary procedure)

If one uses hydration during a chemotherapy infusion and uses it only to facilitate the drug delivery, then you cannot bill it separately. Clinicians may bill the following codes: the HCPCS code for the actual saline; the HCPCS code for the infusion drug; and the drug administration code for the chemotherapy infusion.
If one administers the hydration prior to or after the chemotherapy infusion, you are allowed to bill for the hydration with a modifier -59. Billing with the modifier will inform the payer that the hydration was a distinct or independent procedure.

Case Examples: A Review Of Pertinent Billing Scenarios

- The cases a NP or PA will see on a normal basis will vary from patient to patient. Infusion time can differ with each patient visit and time plays an important role in billing the correct code for the services rendered. When reporting codes for which infusion time is a factor, the AMA recommends using the actual time that it takes to administer the infusion. There seems to be a lot of confusion on how to correctly bill for the new drug administration CPT codes. Accordingly, let us review some examples of billing scenarios with these codes. Example 1: An established 60-year-old female with severe RA presents for her first dosage of infliximab. The patient is currently on methotrexate and prednisone. Clinicians ordered and reviewed a chest X-ray and TB skin test prior to the day of infusion. Clinicians administered infusion therapy for two hours and 38 minutes with 600 mg of infliximab. Appropriate coding: 96413, 96415 x 2, J1745 x 60. Example 2: A 55-year-old man comes in for a scheduled visit for a methotrexate injection and infliximab infusion. The patient also has an E/M visit that involves a problem-focused exam and straightforward medical decision making. The infusion of 580 mg of infliximab lasts for two hours and 28 minutes. Clinicians also injected the patient with 15 mg of methotrexate. Appropriate coding: 99212-25, 96413, 96415 x 1, J1745x58, 96401 J9250 x 3.

Otherwise, when one uses hydration “to facilitate any infusion or injection,” the 2006 CPT Manual states that the following services are inclusive and cannot be reported separately. These services include:
• the use of local anesthesia;
• the start of an IV;
• access to an indwelling IV
subcutaneous catheter or port;
• flush at the conclusion of
infusion; and
• standard tubing, syringes and
supplies.

Pertinent Insights
On Coding For IV Infusions

Clinicians may use the CPT codes 90765 and 90766 to bill for therapeutic or diagnostic infusion when administering any substance or drug other than hydration and/or chemotherapy drugs. These codes are defined as:
• 90765: Intravenous infusion for therapy, prophylaxis or diagnosis (specify substance or drug); initial, up to one hour
• +90766: each additional hour, up to eight hours (list separately in addition to the code for the primary procedure)

Ms. Chung is employed as a reimbursement specialist by the American College of Rheumatology. She is certified as a professional coder by the American Association of Professional Coders. For more information, please contact her at (404) 633-3777.

Rheumatologists commonly use this procedure for the infusion of the drug IVIG. The administration codes for these procedures are time-based. The NP/PA will need to infuse the patient for at least 31 minutes for the first hour to bill (using code 90765). At least 91 minutes will have to pass in order to bill for the second hour, using the 90766 code.

Key Tips On Billing
For The IV Push

The CPT codes 90774 and 90775 are for intravenous pushes. The AMA defines these codes as:
• 90774: intravenous push, single, or initial substance/drug
• 90775: each additional sequential intravenous push of substance/drug (list separately in addition to the code for the primary procedure)

Rheumatology NPs and PAs can use a push procedure to administer the drug methylprednisolone or sodium succinate. Frequently, clinicians would use IV pushes when a patient has a negative reaction to a chemotherapy infusion. The infusion will have to be stopped and a push will have to be done to counteract the reaction. One should bill the push as the subsequent code 90775 with a modifier -59.

A Guide To The Revised Codes For Chemotherapy Injections And Infusions

Currently, 96401 is the only CPT code for the subcutaneous or intramuscular chemotherapy administration. This administration code is defined by the AMA as:
• 96401: Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic

The CPT has changed the introductory language to the chemotherapy section and allowed rheumatologists to code 96401 for the injection of methotrexate. The introduction now includes the administration of chemotherapy agents, monoclonal antibodies and biologic response modifiers for autoimmune diseases other than cancer. Methotrexate is now classed as a chemotherapy agent and can be given by NPs and PAs.

Ms. Collins is employed as a reimbursement specialist by the American College of Rheumatology. She is certified as a professional coder by the American Association of Professional Coders. For more information, please contact her at (404)-633-3777.

The chemotherapy infusion drug administration codes apply to the administration of nonradionuclide antineoplastic drugs and also to antineoplastic agents one provides for the treatment of non-cancer diagnoses (e.g., cyclophosphamide for autoimmune conditions). The codes that clinicians should bill for administering chemotherapy intravenous infusion are 96413 for the first “initial” hour and 96415 for each additional hour up to eight hours.

These codes are defined as:
• 96413: Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug
• +96415: each additional hour, one to eight hours (list separately in addition to the code for the primary procedure).