Question Coding assistance for 96374

[Emmiemireles1]

I keep receiving a denial stating: the benefit for this service is included in the payment/allowable for another service/procedure for the 96374. Can anyone advise me on what i'm doing wrong? Does it need a modifier? The 96374 does share a diagnosis with J1885.

99213 (25)
96365
J3475
J1885
J7030
96374
96375

 

[sls314]

I keep receiving a denial stating: the benefit for this service is included in the payment/allowable for another service/procedure for the 96374. Can anyone advise me on what i'm doing wrong? Does it need a modifier? The 96374 does share a diagnosis with J1885.

99213 (25)
96365
J3475
J1885
J7030
96374
96375

Can you post the MAR with the start/stop times for each drug? That would help clarify what was actually administered. (MAR = Medication Administration Record)

Based on what you posted, the coding doesn’t look correct, but we need more information to advise on what the correct coding should be.

A few things that stand out:

• You’re billing two initial services: 96365 (initial therapeutic infusion) and 96374 (initial IV push).
• You’re also billing 96375 for an additional IV push of a new substance/drug.

I see infusion codes suggesting that 3 drugs were given, but I only see 2 drugs billed:

• J3475 Injection, magnesium sulfate
• J1885 Injection, ketorolac tromethamine

The other J code listed is J7030, which is Infusion, normal saline. Are you attempting to bill 96365 for hydration?

If you can share the MAR details, we can help determine the correct sequencing and administration codes.

It's not clear from the information given whether the hydration is separately billable or not. Even if it is separately billable, 96365 would not be the correct CPT code to use for it.

Also of note - I see an E/M service billed with modifier 25. Just confirming that there was a significant and separately identifiable E/M service performed on this date of service.