Dec 104 min read

Mastering CPT Coding for Drug Administration: A Guide to Precision in Infusion and Injection Coding

Proper drug administration coding is as meticulous as the services themselves. Much like clinicians develop techniques for efficient drug delivery, coders can employ strategies to consistently select the correct CPT codes for drug administration, ensuring compliance and accuracy

Drug Administration Essentials

There are three primary categories for drug administration coding:

1. Hydration (CPT® Codes 96360-96361)

These codes apply to pre-packaged fluids and electrolytes, excluding drug or other substance infusions.
They cannot be reported for physician services in a facility setting.

2. Therapeutic, Prophylactic, or Diagnostic Administration

Refer to the specific CPT codes in Table 1 for administration of drugs and substances (excluding hydration).
Fluid administration to deliver drugs is incidental and not separately reported.
These codes are not applicable for physicians in a facility setting.

3. Chemotherapy and Complex Drug Administration

See Table 2 for appropriate codes.
Includes administration of non-radionuclide antineoplastic drugs, monoclonal antibody agents, and other biologics.
These codes are reserved for highly specialized administrations that require advanced training and patient monitoring.

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Key Tip: When chemotherapy is administered via multiple methods (e.g., IV push and infusion), separate codes are reported for each technique.

Methods of Drug Administration: Mastering CPT Coding for Drug Administration: A Guide to Precision in Infusion and Injection Coding

Drugs may be administered via three distinct methods, each with unique coding considerations:

1. Injection

CPT® 96372 is used for therapeutic, prophylactic, or diagnostic injections (subcutaneous or intramuscular), excluding allergen immunotherapy.
Not reportable in physician offices for injections without the physician present.
Includes codes for non-antineoplastic hormonal therapy.

2. IV Push

CPT® 96374 applies to single or initial substance IV pushes.
Add-on codes, such as +96375 and +96376, capture additional sequential pushes of new or the same drug (within a single encounter).

3. Infusion

Refer to Table 1 for appropriate infusion codes and descriptions.

Important Note: The combination of categories and methods during one encounter requires precise coding to accurately capture the services provided.

Identifying the “Initial” Service: Mastering CPT Coding for Drug Administration: A Guide to Precision in Infusion and Injection Coding

The initial service designation is pivotal in drug administration coding. The determination depends on:

Physician Practice Setting: The primary reason for the visit dictates the initial service.
- Example: If chemotherapy is the primary service, it is coded as the initial service despite additional hydration or antibiotic administration.
Outpatient Facility Setting: A hierarchy defines the initial service:
1. Chemotherapy infusions
2. Chemotherapy IV pushes
3. Chemotherapy injections
4. Therapeutic infusions
5. Therapeutic IV pushes
6. Therapeutic injections
7. Hydration

The service with the highest rank in the hierarchy is the initial service, regardless of the order of administration.

Coding for Multiple Administrations

While only one initial code can be billed per patient per date of service, additional codes account for multiple administrations:

Use subsequent or concurrent administration codes where applicable.
Accurate coding requires understanding time increments, especially for infusions.

Time and Documentation Requirements

Key Time Guidelines

IV Push: Used for infusions lasting 15 minutes or less.
One Hour: Infusions lasting 16–90 minutes.
Additional Hours: Apply only for increments exceeding 30 minutes after the first hour.

Documentation Best Practices

Start and stop times must be clearly documented.
Payer-specific rules may dictate exceptions for incomplete documentation.

Example: If an infusion’s stop time is missing, some payers may allow an IV push code; others may not.

Tables for Quick Reference

Table 1: Therapeutic/Prophylactic/Diagnostic Infusion Codes

CPT® Code	Description	Notes
96360	Intravenous hydration; initial, 31 minutes to 1 hour	Use for infusions lasting 31–90 minutes; not for hydration under 30 minutes.
+96361	Intravenous hydration; each additional hour	Report for increments >30 minutes beyond the first hour or secondary services.
96365	Therapeutic infusion, initial, up to 1 hour	Use for infusions lasting 16–90 minutes.
+96366	Each additional hour	For intervals >30 minutes beyond the first hour.
+96367	Additional sequential infusion (new drug)	Must be a different substance, used only once per mix of drugs in one bag.
+96368	Concurrent infusion	Used for separate bags via the same IV access.

Table 2: Chemotherapy Administration Codes

CPT® Code	Description	Notes
96401	Subcutaneous/intramuscular non-hormonal antineoplastic chemotherapy
96413	IV infusion, up to 1 hour	For infusions lasting 16–90 minutes.
+96415	Each additional hour	For increments >30 minutes after the first hour.
+96417	Sequential infusion of a different substance, up to 1 hour	Used only once per additional sequential infusion.

Table 3: Infusion Timing Guide

Duration	Coded As
15 minutes or less	IV push
16–90 minutes	Initial hour infusion

Mastering CPT coding for drug administration is essential for accuracy, compliance, and maximizing reimbursement. By understanding categories, methods, and proper documentation requirements, coders can ensure precise billing for every encounter.