IV infusions and injections are methods of delivering medication and with continually advancing drug development and increasing utilization they are a fast-growing sector of the healthcare ecosystem. IV Infusions involve inserting a needle into a vein and administering a slower, continuous delivery of medications, while injections, such as subcutaneous or intramuscular, are a quicker, single dose administration of medications. Infusion/injection therapy is increasingly being delivered outside of the traditional hospital setting, with services moving to physician offices, ambulatory infusion centers, and the patient’s home. According to CMS, the components needed to perform home infusion include the drug, equipment and supplies. Nursing services are also necessary to train and educate the patient and caregivers on the safe administration of infusion drugs and visiting nurses also need to assess the infusion site and perform dressing changes[1].
What to Look for?
With the increasing utilization of infusion and injection services, there are many things to keep in mind when looking at the billing. From the codes for the initial infusions and/or injections, any additional subsequent infusions, any medication codes, any allowed supply codes and an appropriate diagnosis, while also making sure any per diem home infusion codes are billed appropriately. And the list goes on and on. With all these variables it’s difficult to keep it all straight.
One area of growing concern is infusion services, specifically ketamine, for the treatment of mental health disorders. Although ketamine is not FDA approved for the treatment of conditions such as depression or chronic pain, there has been increased interest in the use of ketamine for these types of conditions.
Many payors have established Medical Policies that indicate ketamine isn’t covered, but that doesn’t always prevent providers from billing it. So, what do you look for? Ketamine infusions are typically billed with an infusion CPT code and HCPCS code J3490, unclassified drug. There are some claims found where infusions are being billed without any medication codes. Both of these scenarios typically have mental health, or specifically, depression diagnoses associated with the billed services.
HCFS has you covered!
If you’re using the HCFSPlatform™, we have you covered. We have several alerts, that paired with our artificial intelligence (AI) models can help target and identify infusion services and identify infusion services claims being billed for non-covered diagnoses. Some of our most recent alert additions/modifications are:
[2369-01] – MISREPRESENTATION OF SERVICES, KETAMINE INFUSION THERAPY BILLED WITH MENTAL HEALTH DIAGNOSES:[2789-01] – MISREPRESENTATION OF SERVICES, IV INFUSION THERAPY BILLED WITH MENTAL HEALTH DIAGNOSES:[2790-01] – UNBUNDLING, INTRAVENOUS INFUSIONS AND/OR INJECTIONS:
If you have questions or comments, you may email us at [email protected].
If you’re not using the HCFSPlatform™, make 2025 your year! If you’re interested in knowing more, email us at [email protected]
[1]https://www.cms.gov/medicare/payment/fee-for-service-providers/home-infusion-therapy#:~:text=On December 13%2C 2016%2C the,Home IVIG Services Monitoring
HCFS is solely dedicated to providing an efficient, user-friendly solution that incorporates Artificial Intelligence, Pre-pay, Post-pay, Querying, Case Management and Shared Analytics all in ONE integrated platform. Ask about AUDITPLUS – auditing, SVRS, record retrieval and more! Ask about our HCFS Services (record reviews, data mining, you name it!) Click HERE if you want to see a demo!