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Infusion Observation

Dana Posted Thu 21st of May, 2020 17:43:44 PM
96413 and 96415; If the administration of an infusion drug requires 1 hour of observation after infusion can you bill for the time that the patient is being observed. For example, if the total infusion time is 2 hours and they have an hour of observation required (by the drug protocol) can we bill 96413 and two units of 96415.
SuperCoder Answered Fri 22nd of May, 2020 03:22:10 AM

Hello Dana,

Hope you’re doing well!


Thank you for your question.


CPT® code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) is for administration of the chemotherapy drugs intravenously up to a maximum time of one hour. A parenthetical note with +96415 (... each additional hour [list separately in addition to code for primary procedure]) states, "Report CPT® code 96415 for infusion intervals of greater than 30 minutes beyond one-hour increments." These instructions clarify that 96415 represents additional hours of infusion, not observation time, which means you should not report observation time with your case in question.

In your case, you should report the 2 hours of chemotherapy administration as 96413 for the first hour and 96415 (single unit) for an additional hour.


Note: As per CMS, Observation services should not be billed concurrently with diagnostic or therapeutic services for which active monitoring is a part of the procedure (e.g., colonoscopy, chemotherapy).


Hope that helps!


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