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Ketamine infusion with monitoring afterwards

Juan Posted Thu 28th of November, 2019 18:09:00 PM
We are doing a ketamine infusion for a patient for pain and psych. We used these codes: 99213, 96365, 96374 & 96375 along with the J codes for meds. My question is there any code that we can use to show that we did a MAC (monitored anesthesia care) since it is our CRNa that monitored this patient? If we cannot bill for it as MAC how can we bill for the time that we monitored him after the infusion since he just fell asleep and was not ready for discharge immediately. The infusion itself takes about 40 mins to 1 hour. Our monitoring is a 1 on 1. If you can tell me the charting requirements for those codes, I would also appreciate them.
SuperCoder Answered Fri 29th of November, 2019 04:33:06 AM

Hi Juan,

Physicians recognize ketamine as an appropriate agent for conscious/moderate sedation for psych and pain management. So, for payers who recognize the conscious/moderate sedation CPT codes, reporting the use of ketamine as conscious/moderate sedation is appropriate.

Whereas, Monitored Anesthesia Care (MAC) is a type of anesthesia service in which an anesthesia clinician continually monitors and supports the patient's vital functions; diagnoses and treats clinical problems that occur; administers sedative, anxiolytic, or analgesic medications if needed.

There is no applicable Anesthesia code available for the services 96365 and 96374. In this case, MAC is not appropriate to billed separately when performing Ketamine Infusion. Patient fell asleep due the effect of sedative, i.e. Ketamine, then aftercare will be considered as a part of primary service provided.

Hope this helps!

Juan Posted Fri 29th of November, 2019 09:35:18 AM
So how can we bill for the service that has been prolonged by the patient’s need for monitoring? Can we use a 99354 and 99355 to show that we continue to monitor our patient for a prolonged period? Is so can you give me an example of how we can code for another 1.5 hours after the initial treatment?
SuperCoder Answered Mon 02nd of December, 2019 05:21:36 AM

Hi Juan,

CPT 99354 and 99355 can be used for the prolong services. Since, the time duration with the patient after the primary service is big, then CPT 99354 and 99355 can be used for the prolong service. As per AMA guidelines, codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service in the office or other outpatient setting, even if the time spent by the physician or other qualified health care professional on that date is not continuous. Make sure you provide the strong documentation for the medical necessity of patient.

Hope this helps!

Juan Posted Mon 16th of December, 2019 09:42:59 AM
It definitely does help, just a clarification here. If we do an infusion that lasted 1.5 hours, and that patient is monitored the whole time by our staff in a 1 on 1 care (dedicated staff, or provider for that patient receiving the infusion) can we bill 96365, 96366 along with 99354-99355 for that 1.5 hour of care?
SuperCoder Answered Wed 18th of December, 2019 05:04:37 AM

Hi Juan,

Hope you are keeping good.

CPT 96365 and 96366 can be billed for the infusion, whereas CPT 99354 and 99355 are for the prolonged service(s) beyond the typical service time of the primary procedure. So, it is not appropriate to bill both series codes for the same duration of time.

Hope you get the best reimbursement.

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