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Ketamine Infusion Therapy

Mike Posted Thu 21st of August, 2014 16:20:22 PM

Our physician will be performing Ketamine Infusion Therapy in an out patient facility. Looking at the CPT book it says ...codes 96360-96379 are not intended to be reported by the physician in the facility setting?? Only a E/M code should be reported using modifier 25 in addition to 96360-96549. If you cant bill those code why would you need a modifier on and E/M code. We are billing the doctors service separate from the facility. I'm lost- what code can our doctor bill for these services?

SuperCoder Answered Mon 25th of August, 2014 05:31:12 AM

I agree with you that since the provider is not billing for infusion codes, he should not append modifier 25 with E/M code. However, the provider still supervises the nursing staff in administration of infusion service. And that may be the reason why CPT guidelines explicitly says that any E/M service that provider bills, he should append modifier 25. I believe, you should bill E/M service code for your provider appended with modifier 25.

Thanks !!

Mike Posted Tue 26th of August, 2014 17:38:01 PM

so I am correct -I cant bill the infusion codes at all?

SuperCoder Answered Wed 27th of August, 2014 01:10:53 AM

Yes for the provider, you may not bill them. Facility will get reimbursement for them. Thanks !!

Mike Posted Tue 16th of September, 2014 15:57:35 PM

Our doctor is performing the infusion not nursing staff, so what code would I use?

SuperCoder Answered Thu 18th of September, 2014 09:14:34 AM

Even then you may only use the appropriate E/M code for the provider. Only facility will get reimbursement for the infusion codes.

Thanks !!

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