Clearing the Confusion over Infusion Billing, Injection and Hydration Services

Do you know, more than 63% of infusion providers struggle to achieve a seamless billing operation? This is mainly because when it comes to infusion, injection, and hydration services, implementing a seamless billing and coding process can be quite a challenge due to the stringent documentation requirements. Ensuring accurate insurance reimbursements necessitates careful attention to drug code accuracy, billing units, infusion administration charges, appropriate use of CPT®/HCPCS codes, and the application of necessary modifiers. Based on an examination of common claim denial reasons, here are some billing tips for infusion, injection and hydration services to help you avoid potential pitfalls. 

Key Billing Strategies for Infusion, Injection and Hydration Services 

Proper Billing Order: When billing for infusions and injections, prioritize infusion services first, followed by injections/IV pushes, with hydration therapy billed last. 

Allowed Initial Services Per Day: Only one initial code is permitted per patient encounter unless multiple IV sites are medically justified. Also, if the patient returns for a separate encounter on the same day, another initial code may be billed using the appropriate modifier (e.g., modifier 59 for Medicare). 

Know the differences between IV Push and IV Infusion: An IV push refers to an infusion lasting 15 minutes or less, requiring continuous supervision by the administering healthcare professional. For an IV infusion to be billed, it must last more than 15 minutes for safe and effective administration. 

Billing for Sequential Infusions: After completing the initial infusion, sequential infusions can be billed for administering a different drug or service through the same IV access. However, there must be a clinical justification for sequential infusions, and they can only be billed once per sequential infusion of the same solution mix. 

Handling Concurrent Infusions: Concurrent infusions involve the simultaneous administration of hydration, therapeutic or chemotherapeutic infusions through the same IV access. Hydration services administered concurrently are not billable using a HCPCS code and are not separately reimbursable. Chemotherapy infusions are generally not administered concurrently, but if they are, they should be coded using the unlisted chemotherapeutic code. 

Billing Hydration Services: Documentation must clearly establish that the hydration service is medically necessary and not integral to another procedure. The infusion rate should be documented. Hydration is considered an initial service only if it lasts more than 30 minutes. Hydration of 30 minutes or less is not separately billable and should be reported with the appropriate revenue code but without a HCPCS or CPT® code. Additional hours of hydration infusion require an initial service to be documented.  

Documenting Infusion Times: Ensure that start and stop times for infusions are accurately documented. For hydration lasting 30 minutes or less, billing separately is not permitted. If requested, providers should be prepared to submit documentation indicating the infusion volume, start and stop times, and infusion rate. If the stop time is missing, it should be calculated based on the documented volume, start time, and infusion rate. 

Common Documentation Pitfalls 

Incomplete documentation is a primary cause of claim denials, often due to the inability to justify medical necessity. Below are some frequent documentation errors: 

Intravenous Infusion Hydration Therapy –  

• Missing physician orders for hydration fluids administered during drug administration, chemotherapy, or blood transfusion. 

• Lack of distinction between standard care hydration, facility protocols, and drug protocols. 

• Insufficient documentation to support the medical necessity of pre-hydration, simultaneous, or subsequent hydration. 

Infusion Services –  

• Documentation fails to confirm administration through a separate access site. 

• Poor documentation of line flushes between drugs, making it unclear if substances were administered concurrently or sequentially. 

• Missing or inadequate documentation of access sites and start/stop times for each drug, making it difficult to determine if substances were mixed or administered separately. 

• Start and stop times for each infusion are often omitted. 

• Documentation is inconsistent when infusion services initiated by emergency medical services (EMS) are continued in the emergency department (ED). 

• Infusion services begun in the ED and continued during outpatient observation status lack adequate documentation. 

• Collaborating with electronic health record (EHR) vendors to revise documentation forms in line with updated guidelines is often challenging. 

Avoiding Documentation Errors 

To minimize documentation errors: 

• Update and revise documentation forms to align with coding guidelines for injections, IV pushes, and infusions. 

• Ensure clinical staff prioritizes patient care while accurately documenting each encounter. 

• Pharmacists should communicate the classification of drugs, fluids, or substances to facilitate correct procedure code application. 

For the last 15+ years, Sunknowledge Services Inc. has been at the forefront of providing medical billing services to infusion and 39 other healthcare specialties, offering comprehensive billing and coding support across the country. We hope these billing tips for infusion, injection and hydration services will help you secure timely and accurate insurance payments. If you are someone struggling with your infusion billing, Sunknowledge can help.