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Infusion coding question.

Mike Posted Tue 22nd of December, 2015 19:02:39 PM

I need information to help me appeal a claim on infusion. Patient had 3 hours of infusion.
Hour 1 Ketamine infused and preceded by Ativan
Hour 2 Ketamine infused and proceded by Labetalol
Hour 3 Ketamine infused and proceded by Labetalol

We billed:

96365 1 unit
96366 3 units
96375 3 units

J3490 Ketamine
J2060 Ativan
(We borrowed the Labetalol so drug was not billed)

I am having to appeal 96375 because I billed 3 units for the Ativan and Labetalol that was the additional sequential intravenous push on each hour.
CPT says- Report *96375 to identify intravenous push of a new substance/drug IF provided as a secondary or subsequent service after a different initial service is administered through the same IV)

They say this code is use for each "new" drug pushed- so they say I can only bill for Ativan and Labetalol for a total of 2 units on code 96375.

Do you know or have anything on by the CPT assist that addresses this code? Am I looking at the code wrong?

SuperCoder Answered Wed 23rd of December, 2015 08:50:45 AM

Code 96375 wouldn’t be coded as it is an add-on code for 96374. Further 96376 would be coded as 2 unit for another drug. As you have not documented timing for each infusion so appropriate codes for given scenario would be-
96365 Ketamine (First hour)
96366x2 Ketamine (Second and third hour)
96374 Ativan (First new drug)
96376x2 Labetalol (Additional drug)

Mike Posted Wed 23rd of December, 2015 15:03:18 PM

I don't understand "as you have not documented timing for each infusion" I sent a Ketamine Infusion question 5 months ago and it said to bill 96375 for the Ativan. Please refer to this post.

It also says in the CPT only facilities can report this code 96376.
CPT code 96375 also states (use 96375 in conjuction with 96365, 96374,96409 96413)

something is still not correct here. Reading the CPT on page 649 sequential infusion: a sequential infusion is an infusion OR IV push of a new substance OR drug following a primary or initial service. All sequential services require that there be a new substance or drug, except that facilities may report a sequential intravenous push of the same drug using 96376.

We are a doctors office giving 3 and 4 hour Ketamine infusions. We cant use code 96376. Looking at Concurrent infusion: it looks like we cant bill after the second new drug.

Please assist again with this question.

SuperCoder Answered Thu 24th of December, 2015 01:58:57 AM

It was not documented in your first query that services has been provided in office setting not in facility. Earlier reply was given by us assuming that it is facility. Please find below codes for office setting-
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366x2 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
96375x2 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)
You would use the 96375, sequential IV push for each administration as long as an initial service is selected first that can be an infusion or a push depending on the type of drug administered. You cannot bill for a concurrent push into the same IV line of different drugs as there is no CPT code for this scenario. The work of the administration is separately coded as it is considered separate procedures. The drug is added together as a single unit with the total quantity of the drug.
96375 is only reported for an additional push of a "different" substance. To report 96375 for third unit would be incorrect. There is currently no CPT code for additional pushes in the office setting due to they are not common in the that type of setting and no code has been created. My suggestion is to only report the initial push 96374 along with the correct units for the drug but you would not be allowed to report an additional push since 96376 would be the only correct code but has to be in a facility setting. Also FYI - time is a factor in reporting pushes due to any pushes of the same drug can NOT be reported if administered less than 30 minutes apart. Another suggestion is that if multiple pushes are given, since they are not reported in an office setting would be to give intramuscular for those meds that can be given either way. You can always bill 96372 multiple times.

Mike Posted Wed 30th of December, 2015 14:26:20 PM

I believe you are still wrong on code 96374. I you look at the code descriptor 96375 can be used with 96365,96374,96409,96413. (Report 96375 to identify intravenous push of a new substance/drug as a secondary or subsequent service AFTER

Mike Posted Wed 30th of December, 2015 14:31:50 PM

sorry website went down in middle of my question.
96375 is used after an initial service is administered through the same IV access.
We billed 96365 for the Ketamine 96374 would not be coded because only one initial code can be billed on the same day so 96375 is billed.

SuperCoder Answered Tue 05th of January, 2016 02:33:44 AM

In defining sequential infusions, CPT® points out that sequential refers to administration of a new substance or drug. (There is an exception for facilities: +96376 [Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)]. This is stating that non-facility sequential IVP's of the same drug cannot be reported separately. Physicians should not report +96376.

For above scenario, 96375 can’t be billed for 3 unit.

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