by Angela Lima, BS, CCS, CDIP, COC, CIC, AAPC-Approved Instructor

One of my responsibilities as an outpatient coder was CPT coding of injection and infusion services for the facility side for both the Oncology Unit and the emergency room. It was an opportunity to broaden my knowledge of a very specific coding challenge.

The hardest part for me to understand was that a sequential infusion or injection push that was administered does not necessarily mean it was given sequentially in time. Coding infusions is not like watching dominoes fall where the first domino is initial and the second is sequential. Far from it.

For facility reporting, whether an infusion or injection push is the initial or sequential service is based on the hierarchy: chemotherapy is the top of the hierarchy pyramid, followed by non-chemotherapy agents, followed by hydration. A sequential infusion is an infusion or injection push of a new substance or drug that is lower in the hierarchy than the initial agent. The definition does not talk about when the substance or drug is given relative to any other agent being given. For example: a patient can be given an infusion or injection push of a non-chemotherapy substance before the chemotherapy is started. Per the hierarchy, chemotherapy would be the initial agent and the other agent, although given before the chemotherapy started, would be the sequential.

An additional challenge for both nursing staff and coders is the documentation of time. It is not enough for the documentation to state that the infusion ran for 30 minutes — actual time the infusion started and the time the infusion ended must be written in the record by the nursing staff. What this meant at our facility is that the coders learned how to calculate elapsed time. To make it easier, the old analog clocks on the unit were changed to digital.

While injection and infusion coding was never a big part of my work experience, I am happy that I had the opportunity to learn how to do it correctly. I would encourage anyone to embrace a new challenge that comes their way and make the new skills part of their personal tool kit.


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