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Billing infusion codes

Lindsay Posted Fri 15th of November, 2013 11:20:55 AM

Can you have more than one "first" hour over an extended inpatient hospitalization? i.e. (first per day? or only one first for entire encounter)

SuperCoder Answered Fri 15th of November, 2013 18:29:37 PM

When you’re reporting a range of dates, guidance typically says to use one initial code (with the exception that another initial code may be reported for a second access site, which allows for reimbursement of the time and effort involved in providing that additional site).

Although it mentions outpatient reporting in the section, CPT Assistant Dec. 2011 states:

“For facility reporting over a range of dates, the specific medication-administration example of an intravenous (IV) push medication individually prepared and administered at 10 PM and 2 AM, would only be reported as initial (96374) and the 2 AM administration would be reported as sequential (96376) provided: (1) no other infusion services were performed that would alter the hierarchical reporting structure; and (2) the push of the same drug was performed more than 30 minutes beyond the initial administration, as indicated in the parenthetical instruction following code 96376.

“Example: The same drug is individually prepared and administered through the same vascular access site over one hour each at three separate times in the observation setting, with the third infusion commencing past midnight.

“How to Code: Code choice is dependent on whether reporting for service(s)/procedure(s) performed on a single calendar date or over a range of dates. If performing single calendar date reporting, the third infusion started after midnight, would not be reported with code 96366, but rather with code 96365, as this now represents the initial infusion for that new calendar date. Therefore, the first two doses prior to midnight would be reported with codes 96365 and 96366, respectively. Any additional infusions on that calendar date through the same IV site would follow the reporting hierarchy.

“If reporting over a range of dates, another initial infusion code (96365) would not be reported for the dose administered after midnight. Instead, code 96366 would be reported.”

CPT 2014 guidelines also give the 96374 and 96376 example for different DOS. It also gives a 96360/96361 example for continuous infusions that go past midnight.

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