Medicine/Hydration, Therapeutic, Prophylactic, Diagnostic Injections, Infusions
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?
Answer: Hydration, injection, and infusion services (codes 90760-90779) typically require direct physician supervision. The physician work predominantly involves affirmation of the treatment plan and direct supervision of staff. The total valuation of these services primarily reflects the practice expense of infusion clinical staff, which would not be borne by the physician in the facility setting. For CPT 2008, these codes are not intended to be reported by the physician in the facility setting as noted in new introductory language. However, the facility may report these services, even if the physician may not. New instructions for code 90772 allow hospital reporting when the physician is not present to provide direct supervision.
Although the physician may not report the hydration or drug administration service in a facility setting, it may be considered acceptable to some payers for the physician to report work involving the affirmation of the treatment plan and direct supervision of staff when the physician is physically present in the area, provides direct supervision, and affirms the treatment plan. The physician work of these tasks was valued as being at least the work of a code 99211 by the RBRVS Update Committee.
CPT does not contain a specific statement regarding reporting code 99211 in this circumstance; therefore, it is appropriate to check for payer policy. If the clinical conditions warrant a separate E/M service, then that service, not code 99211 would be reported. Remember, the site of service reporting for any such E/M, including code 99211, must reflect the facility site. Documentation to support code 99211 reporting by the physician should note presence, affirmation of the plan, and direct supervision.
No documentation would suffice to allow reporting of codes 90760-90779 by a physician when these services are provided in the facility. Also, it is not appropriate to report any E/M codes for services solely related to referring a patient to an infusion facility with orders, but without being present for the infusion, even if available remotely for telephone consultation.
CPT Assistant; August, 2008, pp. 12-14