Return to LYNX Lines Table of Contents
Bundled Injection & Infusion Codes
Ann Florer, RN, CCS-P
Corporate Compliance Analyst
Medicare bundles more infusion and injection administration codes with procedures under OPPS
During an Open Door Forum call on September 21, 2006, the Centers for Medicare and Medicaid Services (CMS) stated that if a National Correct Coding Initiative (NCCI) exists for drug administration services under the Outpatient Prospective Payment System (OPPS), coding principles behind them apply throughout the OPPS.
Previously, CMS did not include NCCI edits for infusion and injection codes in the OPPS. However, CMS has now adopted these edits for OPPS and LYNX will code compliantly to these edits. A -59 modifier will only be used to bypass an edit if the injection or infusion was performed at a different patient encounter on the same date of service or per NCCI edit coding principles. This may result in a decrease in the number of infusion and injection codes that are assigned in your Emergency Department (ED).
An injection for pain relief following an outpatient surgery is packaged into the surgery, and it is not proper to append modifier -59 to get the injection pain. The CMS Web site, OPPS Guidance for Drug Administration, lists the following FAQ:
Q4. How should hospitals bill the administration of pain management medication for beneficiaries placed in observation after an outpatient procedure?
A4. In general, payment for the outpatient procedure includes both post-procedure recovery services and associated pain management treatments. Contact your local FI for specific billing guidance
Noridian Administrative Services, LLC, local FI administrator for 12 states: Alaska, Arizona, Colorado, Hawaii, Iowa, North Dakota, Nevada, Oregon, South Dakota, Utah, Washington and Wyoming, has clarified that infusion and injections given as part of a cardiopulmonary resuscitation are bundled and should not be separately charge coded. “All activities that are essential to the delivery of the service are included in the ambulatory Payment Classification (APC) for the service.” A NCCI edit exists for CRP code 92950 and the infusion and injection codes.
No clarification was provided as to coding for injections for non-pain related conditions (e.g. nausea, vomiting) post-operatively. Facilities are encouraged to contact their local fiscal intermediaries (FI) as to which infusions and injections they consider to be integral to procedures, especially regarding those injections and infusion services which not all patients having the procedure receive. Facilities should continue to charge for the drugs injected or infused using the appropriate J code. Although many J codes are considered a packaged service under OPPS and are not separately reimbursed, others classified as non-pass-through drugs are paid separately and reporting is essential for determining future APC assignment and rates.
The information contained herein is provided for informational and educational purposes only, and nothing contained herein should be construed as advice. All information contained herein is obtained by LYNX Medical Systems (LYNX) from sources believed by LYNX to be accurate and reliable. Because of the possibility of human and mechanical error as well as other factors, LYNX is not responsible for any errors or omissions. LYNX makes no representations and disclaims all expressed, implied, and statutory warranties of any kind to user and/or any third party including warranties as to accuracy, timeliness, completeness, merchantability or fitness for any particular purpose.