infusion coding

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    Question Concurrent Infusion 96368 (Different IV Site - Not Meeting Medical Necessity to Report Second Initial 96365)

    I/I Coding Scenario: 2 IV sites (LT & RT antecubital) Note: For the second I/I site (right antecubital), the provider did not document the reason for second iv site placement which is required to support medical necessity Drugs given: Diltiazem given at left antecubital site from 13:26-17:54...
  2. G

    Umbilical Cord Derived Mesenchymal Stem Cells Research

    Patient receiving two doses of intravenously administered umbilical cord mesenchymal stem cells separated by a 72+ 6hour interval. Per Study the UC-MSC administration via intravenous infusion that fall under the allogeneic CPT category since the mesenchymal stem cells are umbilical cord-derived...
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    cpc with outpatient, hospital and facility experience

    Nichole Morris, CPC NicholeHMorris85@gmail.com Medical Billing & Coding Accomplished professional with solid background in health care clinical operations, including medical billing and coding standards, financial policies, and medical record documentation. Expertise in insurance...
  4. N

    96523 Port Flush

    This question has been brought up to me "Saline flushes for PICC and Ports, is there a cap on how many you can charge for? Ex. PICC's actually have NS 20ml flushes for each lumen and there are two lumens. Nursing is only charting on 1 lumen. Can we get more reimbursement for all 4, or no?"...
  5. M

    CPT 96365 and 96367 in Outpatient Hospital Setting

    Hello all. I'm wondering if anyone can help. I'm auditing an outpatient UB that has 96365 on 10/9/18 and 96367 on 10/10/18. I'm new to Outpatient coding and was wondering if billing these on different dates of service is allowed. The itemized bill does not have times or anything like that...
  6. I

    Ifustion Coding - Only for Chemo?

    Are the CPT codes for chemo infusion also allowed for use for non-chemo agents?
  7. A

    Physician E&M service same day Facility Infusion

    I hope I can get someone to shed some light on this issue. physician E&M service and facility infusion on the same day- So in peds, often times, the physician ends up seeing the patient on the same day as infusion therapy that is billed by the facility. Since the clinic and infusion suite...
  8. S

    Hydration or Therapeutic Administration Question?

    Hello. I have a question in regards to hydration and infusion coding. Here's the scenario: Patient came into the ED with abdominal pain and had developed nausea and vomiting. The MAR states "Dextrose 5%-0.45% NaCL 1000 mL + 20 mEq KCL Intravenous at 125 ml/hr." Would this be coded as...
  9. G

    Infusion coding help please!

    If a patient is receiving hydration (Normal Saline 500cc) and magnesium is added into the bag, are we able to charge for the both the Magnesium (J3475) and the bag of Normal Saline 500cc (J7040) it was added to? I realize that I can only bill the Therapeutic IV 96365 code, and not hydration...
  10. B

    Infusion Therapy Billing

    Hello, I've been away from Infusion billing for a few years now and am about to start billing for an infusion therapy center again. I'm confused on Medicare and Commercial Billing. Medicare billing is daily basis correct? Unless DME provider and bill Pumps, etc. to DMERC. Now say if a...
  11. A

    -59 Modifier on HCPCS codes

    We are having an issue where Regence is denying the second line of J9055 because "modifier -59 is not valid with HCPCS code J9055." We are billing separate lines to bill 2 different NDC#s. How are we to code the two lines without modifier -59? Do we bill without a modifier or just lump the 2...
  12. R

    Cpt 96365

    Cpt 96365? Nobody knows??? Do not report for services provided by physicians or other qualified health care providers in facility settings. What does this mean exactly for CPT 96365? I am so confused Can an CRNP or MD in an outpatient facility bill for 96365?
  13. L

    Administration coding

    Hello, I am wondering if I can get a few opinions on how these two cases would be billed. I'm not including dosages and pre-meds. I'm really only concerned about two drugs and what administrations are billable. I was instructed to bill 96413, 96415, 96368, 96411 for both cases. First case...
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