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POLICYSeveral claims have been received where codes 90760 (Intravenous infusion, hydration;initial, 31 minutes to 1 hour) and 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) are being submitted on the same claim. Both codes indicate an initial injection and/or infusion being administered.
In accordance with CPT guidelines, when administering multiple infusions, injections or combinations, only one "initial" service code should be reported, unless protocol requires that two separate IV sites must be used. The "initial" code that best describes the key or primary reason for the encounter should always be reported irrespective of the order in which the infusions or injections occur. If an injection or infusion is of a subsequent or concurrent nature, even if it is the first time such service within that group of services, then a subsequent or concurrent code from the appropriate section be reported (eg, the first IV push given subsequent to an initials one-hour infusion is reported using a subsequent IV push code.)
When submitting two initial codes on the same day, as appropriate, modifiers should be used and appended to indicate separate and distinct IV sites were used and supported by documentation.
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY1/2008: Policy written