Managing an In-Office Infusion Practice

Carefully research how to acquire medications for your infusion center. Begin by examining your patients’ individual prescription drug policies and procedures, and then research various vendors to verify that you are getting the most competitive price on the drugs with guaranteed availability.

Coding for Infusions

When coding for infusion services, there are specific coding and documentation guidelines to follow. Table 2 is a sample table for infusion code descriptors. Use the most recent CPT and HCPCS manuals to ensure you receive the correct reimbursement. Coding and billing staff must also be aware of code changes as well as any new categories for drug administration and infusions. Policy changes can be found on each carrier’s website under the medical policy section. Coding changes can be found in the newest CPT, ICD-9, or HCPCS books that come out each year.

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Table 2: Sample Infusion Coding Chart

There are specific coding rules for drug administration charges. For example, there can only be one initial code in the drug administration family, and all other codes must use a subsequent code. The supplies for local anesthesia, IV start, access to indwelling IV, subcutaneous catheter or port, the flush at conclusion of infusion, and standard tubing, syringes, and supplies are included in the relative value of the drug administration code and cannot be billed separately.

Infusion codes are based on time, so accurate documentation of the start time is strictly enforced. The documentation of time is essential for appropriate billing and reimbursement. See this month’s Coding Corner on page 18 for an example scenario. Also, download the ACR’s Rheumatology Coding Manual for more information on billing and coding specifically for rheumatology services at www.rheumatology.org/publications and click on Practice Management Publications.

Offering in-office infusion services for your patients has challenges, but it gives you the opportunity to provide the best standard of care at the point of service to your patients. It also opens the door for enhancing your practice through increased patient recruitment. For questions on coding and billing for infusion services, contact Melesia Tillman, CPC, CRHC, CHA, coding and reimbursement specialist, at mtillman@rheumatology.org. For questions on the management of an infusion center, contact Cindy Gutierrez, insurance and practice management senior specialist, at cgutierrez@rheumatology.org.