Injections and Infusions Tool

Injection and Infusion Tool for Emergency Department/Observation Charge Capture

This tool is designed to assist in the appropriate documentation and capture of injection and infusion services performed in an emergency department. This tool recognizes the facility hierarchy for reporting these services and is not appropriate for use by physicians. It does not include chemotherapy services as these are not typically performed in the emergency department setting. This tool is published as a DRAFT with a request that the end user critique and respond to help us design the most usable format for appropriate documentation and charge capture.

 Rules and Definitions:

The CPT^® facility hierarchy defines the methodology for reporting injection and infusion services. Only 1 initial service may be reported per encounter per needle access (puncture) site. All other services through the same access are reported as secondary services not “initial” services. An “initial” service may be reported for each access (puncture) site. Additional access (puncture) sites should be reported with modifier -59 to alert the payer of the “separate” access site.

At each access (puncture) site to determine which service should be reported as the “initial” service, the following rules apply:

• Chemotherapy services are primary and reported before therapeutic, prophylactic or diagnostic services. Chemotherapy services are not considered on this tool, however if they are performed would be considered “initial” over any services reported on this tool.
• Therapeutic, prophylactic or diagnostic IV Infusions (16+ min)
• IV Push (15 min or less) IV Hydration (31+ min)
• Heplock/KVO – ONLY reported if no other service is performed.

The numbers to the left on the tool correspond to the hierarchy. Number 1 indicates the service would be reported as “initial” if other services were performed at the same time through the same access. Number 2 would only be reported as “initial” if there was no number 1 reported and so on.

 Service

This column describes the type of injection or infusion performed.

• Heplock/KVO – this service describes a small amount of fluid infusing to keep the vein open for quick access to deliver meds. This service may not be reported if any other service is provided through the same access (puncture) site.
• IV Meds Therapeutic Infusions (includes Therapeutic, Prophylactic or Diagnostic) – Administration of substances or drugs other than hydration. According to CPT^® if fluids are used to administer the medications, they are not separately reported but considered incidental to the infusion.
• Additional Med following 1^st IV Med Infusion – a sequential infusion in the same IV access site of a different medication/substance. Infusion of a second/subsequent medication/substance following an initial service. This service is reported only once per infusate mix.
• IV Piggy Back – a concurrent infusion of a second medication through the same access site; two bags hanging entering through one line. THIS DOES NOT REPRESENT A MEDICATION AND A FLUID RUNNING AT THE SAME TIME. (See IV Meds Therapeutic Infusion).
• IV Push Med – push of a medication lasting 15 minutes or less. Includes therapeutic infusions less than 16 minutes or those without documented start and stop times. List each injection separately based on the medication/substance administered.
• IV Fluids Hydration – Infusion of fluids such as normal saline, pre-packaged fluids and electrolytes, not medications. Must last at least 31 minutes to report.
• Vaccinations – Includes flu shots, tetanus, Hepatitis, rabies etc. injections. List all given by substance, route, date and time.
• Subcutaneous / Intramuscular Injections – List medication and dose and time for each injection given.

 Use by Nursing Staff

Instruct nurses to read the columns down and fill in services by access site (puncture) through the skin. Each service should be reported with its associated medication/substance, dosage, start and stop times or for injections administration time. Refer to the Coding worksheet for appropriate code assignment.

This tool considers a patient in the Emergency Department or Observation setting and does not consider any other site of service. When considering CPT codes for reporting of “initial” injection and infusion services in a facility they should be reported per encounter not per day. For example, if a patient comes to the ED at 11p.m. and a therapeutic infusion is started, the patient is transferred to observation with the infusion in place. Following, at 2am, the infusion is stopped and the patient discharged. Only one initial service would be reported with the subsequent hours for the complete infusion service.

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