Cahaba GBA Reminds Providers: Correctly Code Infusion and Injection Services

on Thursday, 24 March 2011. All News Items

In an article released March 23, 2011, Cahaba GBA, the Medicare Administrative Contractor (MAC) for Jurisdiction 10, reminds providers that CPT codes for “initial” chemotherapy and therapeutic (non-chemotherapy) infusion services are generally to be reported only once per day. This article is in response to data analysis that indicates providers are submitting claims for initial infusion services with excessive units. One (1) unit of service should be reported for CPT codes 96413, 96365, and 96369 per day of service. Exceptions are when a patient has two separate intravenous lines or two separate visits on the same day. In these cases, more than one unit of an initial service may be reported, but the second initial service must be appended with a 59 modifier to indicate it is a separately identifiable service. Modifier 59 should not be used simply to bypass a CCI edit, but only when separate and distinct services are provided. The article also reminds providers that services provided/ordered must be authenticated by the author and signatures must be legible.

MMP, Inc. routinely verifies the correct coding of injections and infusions as part of our UB04 reviews. If you are an MMP client, look back at the outpatient reviews to see if this is an area of concern identified in your facility by MMP, Inc.

A copy of Cahaba’s announcement can be viewed on the Resources page of MMP’s website (www.mmplusinc.com) titled “Billing Correct Units for Injections and Infusions”. Cahaba GBA will likely publish the article in the near future on their website (www.cahabagba.com) in the Part A section under What’s New.

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