Learning to Code Injections and Infusions

Learning to Code Injections and Infusions

by Angela Lehoux, BS, CDIP, CCS, CIC, CPC-I

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.


Proper coding of Injections and Infusions leads to accurate reimbursement and less frequent denials. However, this type of coding may not be easily understood by just reading through the guidelines. Demystify this difficult topic with the course Injection and Infusion Coding for Facilities

About the Author

Angela Lehoux, BS, CDIP, CCS, CIC, CPC-I
With over 25 years of experience in inpatient, outpatient and emergency room coding, Angela is an Education Specialist, Instructor and Director of Education for Libman Education. Angela teaches Libman Education’s Medical Coder Career Program (MCCP), courses on ICD-10-CM and ICD-10-PCS, and courses for the CCA, CCS, CIC, and COC credentials. Angela holds a bachelor’s degree in Healthcare Management, Certified Coding Specialist, Certified Documentation Improvement Practitioner from AHIMA, Certified Inpatient & Outpatient Coder and the Certified Professional Coder Instructor certifications from AAPC.

5 thoughts on “Learning to Code Injections and Infusions

  1. judith Barbosa - August 28, 2019 at 3:49 pm

    does it cost anything for this webinar? Also do I get CEU’s?

    • Libman Education - August 28, 2019 at 6:15 pm

      Hi Judith,
      Thanks for the inquiry. We offer an online, self-paced I&I course for $59. Those who successfully complete it are eligible for 1 AHIMA and 1 AAPC CEU. More about the course here:

      Hope this was helpful. Let us know if you have any further questions. Thanks!

  2. Deanna - August 28, 2019 at 5:58 pm


    In the article you mention time documentation. A lot of facilities are now implementing hard stops or reminders in the EHR, which is a good control point to ensure time is documented for infused drugs. One question I have had, has been regarding charging due to bag overfill. If an order states that a drug is to be infused for 15 minutes, but due to bag overfill, the infusion runs for 20 minutes, do you code a push or initial code? Are there any guidelines regarding bag overfill and charging infusions?

    • Deanna - August 28, 2019 at 6:03 pm

      Correction on my post – Do you charge a push or an infusion code, not necessary the initial?

      • Libman Education - August 30, 2019 at 3:11 pm

        Hi Deanna,
        According the the CPT guidelines the infusion is charged based on the actual time it is infused. The CPT guidelines do not address bag overfill. If the infusion runs for over 15 minutes it is an infusion and not a push.

        Thanks for the inquiry – hope this helps!