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NEW IV IN CLINIC

Peter Posted Tue 14th of May, 2013 16:06:18 PM

DOCTOR HAS DECIDED TO DO NEW IV IN THE CLINIC, THE MEDICINES WOULD BE DEPAKOTE AND KEPPRA. COULD YOU PLEASE DIRECT ME IN THE RIGHT WAY TO CODE THIS. WE HAVE NEVER DONE IV'S IN THE OFFICE. I NEED TO KNOW WHAT CPT CODES TO USE. THANK YOU SO MUCH

SuperCoder Answered Wed 15th of May, 2013 14:05:57 PM

Coding drug admin requires knowing the administration method (you list both as IV) and timing (start and stop times should be documented). The specific drug administered is also important. For instance, check whether the patient is getting Depacon instead of Depakote.

So if the patient receives a 60-minute Depacon infusion and a 15-minute IV push of Keppra, you should look at:

* 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) for the 60-minute infusion

* +96375 (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)) for the IV push.

Review the guidelines with the infusion codes for important information about how to choose the initial and sequential codes (the order given is not the deciding factor) and understanding time requirements (e.g., one definition of push is an infusion of 15 minutes or less).

If your practice bears the cost of the drugs, you’ll also want to look into coding those. E.g., unclassified drug code J3490 for Depacon and J1953 for Keppra. Be sure to follow the payer’s rules on supporting info for J3490 and report the appropriate number of units.

You’ll also want to check to see whether the payer has specific diagnosis/medical necessity requirements for coverage of the IV versions of these drugs (as opposed to oral).

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