The 2008 CPT book is out. For the past few years, there has been some controversy about ER docs using IV infusion codes in the ER. The language did not expressly prohibit it, and some payers would actually reimburse for it (though not all), so many ER doctors added these codes into their charge master.
For our part, we did not. There were several reasons. First of all, the documentation requirements are, not exactly onerous, but detailed enough to represent a significant obstacle to compliantly billing for that service. It would require a fair amount of attention and education of our doctors to ensure that the charting matched the charges, but doctors these days are absolutely overwhelmed with "educational mandates" like patient satisfaction, joint commission, quality and "pay for performance", and even some actual medicine, too. People only have so many incoming information channels, and doctors are saturated. So I preferred to focus on maximizing the documentation of the more "legitimate" and common services like critical care and fracture care, which in the end are far more valuable.
Also, I rather suspected that IV infusion was never intended to be a code for ER doctors to use, and that it was an oversight which would be corrected. For a doc in an office or a chemotherapy infusion center, there are costs to be covered and in the absence of a separate E/M charge, the infusion code represents the entirety of the physician work, which should be reimbursed. But in the ER, the facility bears the overhead of the infusion, and the infusion is really just accessory to the diagnosis and management work, so it doesn't make sense to reimburse for it as a separate line item.
And I have been proven right (yes, it does happen on rare occasion). The new language of the "Hydration , Injection and Infusion" codes does appear to preclude further use in the ED setting. Page 383 reads:
“Physician work related to hydration, injection, and infusion services predominately involves affirmation of treatment plan and direct supervision of staff. These codes are not intended to be reported by the physician in the facility setting.Emphasis added. Well, that settles that.
When these codes are reported by the facility, the following instructions apply. The initial code should be selected using a hierarchy whereby the chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy does not apply to physician coding.”