Priority Management Group – CHC Billing Experts

Question: May the therapeutic, prophylactic, and diagnostic injections and infusion codes be reported when these services are provided by the nursing staff employed by the hospital (ie, hospital outpatient department)? Can the facility report the infusion codes for the nursing staff providing these services and can the physician also report these codes for supervising the plan and treatment? If so, what are the documentation requirements for the physician to be able to report these codes in a hospital outpatient department?

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Question: An insurance company has refused to pay for an Evaluation and Management (E/M) Office or Other Outpatient Services code (eg, 99214) and procedure code 90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, when they are both reported on the same date of service. They state the office visit is inclusive to the procedure. What is the appropriate way to report these services when the two (ie, the E/M visit and the intravenous infusion) are unrelated?

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