What does infusion mean in medical billing & coding?

Infusion billing refers to the process of billing medications or fluids given to patients at homes, providers' offices offering in-house procedures, and standalone clinics or centers. This category of medical billing falls under Medicare Part B (Outpatient/Medical coverage).

The process of billing for this service is quite complicated and becomes a major cause for concern for healthcare providers as incorrect billing can result in denial of claims, rework and ultimately, loss of revenue.

Before we go deeper into the subject, let’s look at some common bottlenecks that can adversely impact infusion billing.

Building a better approach to Infusion coding

Using the correct code for every billed item is crucial to achieving success with infusion billing. The medical codes for infusion and injection procedures are based on Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) description of services. To ascertain which code is applicable, the following factors must be considered:

• Route of administration: Refers to the mode of administering a drug. There are several techniques to administer a medication but the best mode varies from patient to patient and their medical requirements. The most commonly used routes of administration are Intravenous (IV), Intravenous Pushes (IVP), and Injections (Sub-Q/IM).
• Medication type/Service level: Refers to the complication/level of service of a medication viz. High level, Low level and Hydration.
• Duration of the service: Refers to the time from when the medication starts flowing through the drip, to when the procedure is complete. Whether a service can be billed for one hour or more and what billing code to apply depends on the time bracket it falls under, as defined by the American Medical Association (AMA).

What are the billing challenges of infusion centers?

As might be apparent from the discussion above, there are a bunch of factors that determine which billing code will be applicable. Therefore, the lack of experienced billers, or the inability to handle the pressure of processing hundreds of bills daily, can have a negative effect on the accuracy and output of infusion billing operations.

Although there are enough resources available online for clinical billing professionals to refer to, whenever in doubt, these codes and definitions are frequently updated and can become difficult to keep up with.

Moreover, the typically high wages of an experienced biller or coder can increase operational expenses and quickly turn into a serious burden for smaller practices.

Can outsourcing infusion billing help?

In short, yes. Accuracy in clinical billing operations is as important as processing them quickly. In order to ensure both speed and accuracy, infusion practices should invest in qualified medical billing professionals and automated billing and coding software. Providers lacking the sufficient infrastructure to put these processes in place may consider partnering with a Revenue Cycle Management company providing specialized infusion billing services in a more efficient manner and at a price that is pocket-friendly. It is an investment in the financial health of the practice, and can really work wonders in changing the revenue-generation landscape.