1. D

    Infusion admin 96365 / possible reaction

    Looking for assistance with 96365. Infusion started and then stopped at 3minute mark due to patient condition. May we still bill the 96365 with a 52 modifier? Patient was continually monitored for almost an hour before discharge. Any guidance will be appreciated. Thanks, Donna
  2. K

    Drug therapy requiring monitoring for ongoing treatments

    So I have mixed thoughts on the MDM area for what can qualify as drug therapy requiring monitoring. I know the guidelines of what drugs qualify, however what about patients that are on radiation therapy or chemotherapy and we are continuing the same treatment with no changes. Does this still...
  3. K

    Question Prolonged infusions G0498 vs E0781 and 96416

    So I know G0498 encompasses 3 components: the initiation in office, the continuation at home, and the follow up in office at conclusion of infusion, along with the supplies/device, however when would you choose this code versus choosing to bill the E0781 along with the initiation code 96416? I...
  4. M

    Facility charge for an infusion clinic...?

    Hello! I am coding for a outpatient infusion clinic facility, not professional fees- Should be easy, right?! Yea, sure! My questions do not revolve around the infusion coding. I cannot find any written resources on charging a facility E&M for an infusion services. I didn't think we could charge...
  5. D

    Question IV Billing without Rheumatologist

    Is it acceptable for a Rheumatologist to bill for infusions when he is not in the office/infusion center? The office will have another non-Rheumatologist physician in the office/infusion center when the Rheumatologist is gone. What is the appropriate method to bill and are there references for...
  6. I

    Help with billing Anthem and Tricare S9494

    I'm hoping someone has an idea what we can do to override a problem we are having between Anthem BCBS and Tricare for Life. We are an infectious disease clinic and many of our patients opt to infuse themselves at home rather than come to the clinic daily. We are not involving a home health...
  7. G

    Physician Infusion Services, CHONC Practice Exam Clarification.

    Hello, I was hoping for clarification on a topic that has me torn as to the true and correct coding method. The below scenario and rationale comes directly from the CHONC Specialty Practice Exam. Prior to this I have previously been taught that we can only bill a IV push as primary to a...
  8. E

    Medicare Denials - Infusion Coding Guidelines

    Recently, Medicare has denied some infusion, injection, and hydration charges on our observation claims due to not having an initial service billed for each date of service on the claim. Our HIM Dept is stumped because we have always followed the coding guidelines that only 1 initial service...
  9. 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...
  10. 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...
  11. J

    Medication infusion and hydration billing

    Good evening, I would greatly appreciate any advice on the following topic: In the oncology department some patients receive hydration as well as their medication either due to dehydration, or due to the renal toxicity of the chemo. Hydration is given per the doctor's order. Previously our...
  12. J

    Infusion/hydration question

    Good afternoon, I would greatly appreciate any advice on the following topic: In the oncology department some patients receive hydration as well as their medication either due to dehydration, or due to the renal toxicity of the chemo. Hydration is given per the doctor's order. Previously our...
  13. aimeeread

    CAR-T cell infusion

    Hello, I am now receiving direction that I should be billing for CAR-T cell infusions. Has anyone else ever seen these? If so, what code(s) did you use to bill for this procedure? I have read everything I can on this trial...and the closest thing I can come up with is 36511 (apheresis for...
  14. S

    Infusion Start/Stop times vs. New Bag start time

    I need guidance, please. What are general thoughts regarding using new bag time as a stop time for previous infusion? I am being told that when it is documented that a new bag was started, that will count as the stop time for the old bag. I don't agree with this. My thoughts are that you...
  15. M

    Home Services

    We do infusion therapy for some of our patients, but instead of doing them in house they take their medications home with them so that it is cheaper. They are able to do their own infusions without the aid of a medical staff or facility. We are on the fence about how this should be billed out...
  16. P

    IV Infusions without site, volume or rate...Can we still charge for them in the ED?

    I know good documentation is required for IV medication administration but sometimes we do not have certain criteria listed. We use EPIC and sometimes certain things are not added in by the nurse such as the volume or rate or site. Can we still charge for IV medication infusions without the...
  17. B

    ED injection and infusion codes

    Hi I am looking for a nice article or free resource that explains ED infusion and injection codes. Does anyone have a good resource? I seem to remember a HealthCare Business Monthly article, but I can't find it Thank you! Becky
  18. 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...
  19. C

    Infusion and Transfusion Bundle?

    Hi All! If a patient is in the OR and receives blood products and clotting factors, would it be proper to code both the transfusion (36430) and the infusion (96365)? Thanks very much!!
  20. J

    Z51.11 and Z51.12

    If a patient is receiving a few different infusions, some anti-neoplastic and some Immunotherapy, at the same time. Do you use both Z51.11 and Z51.12? I usually just use the Z51.11 and haven't had a problem but I am questioning what the correct thing is to do? Thanks
  21. 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...
  22. J

    Coding an infusion when there is a "pause" in the infusion

    We are having a difficult time trying to find any information on how to treat this particular instance. The scenario: A patient comes in for infusion, it starts at 8:00 but at 8:45 they pause it because of a reaction, it is resumed again at 9:00 and continues for another hour. Is that 15...
  23. S

    Infusion Documentation/Form

    Does anyone have a form they use for documenting infusion procedures, or a link or suggestion for where to look? I want to have a form or something to prompt the provider to fill in all the correct blanks to fully support the documentation of infusion procedures. I have all the information...
  24. N

    infusion scenario

    I am going over coding scenarios for ED infusion and injections. Documentation from the ED Physician Notes: Administered Medications: •19:21 Drug: Zofran 4 mg Route: IVP; Site: left antecubital •20:54 Follow up: IV status: Completed infusion Response: No adverse reaction; Nausea is decreased...
  25. L

    ED charges for same drug push and infusion

    Do I charge IV Push of Heparin when they also have Heparin Infusion? Or do I only charge for the infusion? I cannot find any guidelines concerning this situation.
  26. Colliemom

    Remicaid infusions

    Hi guys, I was hoping someone could help us. A patient came in for a Remicaid infusion. The drug was mixed, and the infusion started. During the infusion the patient had a reaction and the infusion had to be discontinued. Because the drug was already mixed, the remaining infusion had to be...
  27. K

    paracentesis - help!

    Our providers are always coding 96365 with the paracentesis codes in order to capture the albumin infusion. I delete the 96365 code due to CCI edits. Everybody is divided here as to whether I should be doing this. Does anybody know whether I am making a mistake by dropping the infusion code?
  28. N

    Infusion & Injection 99366 & 99367

    Infusion & Injection 96366 & 96367 Hello I am new to infusion and injection coding. I have been finding resource with examples to code; however, I am having issues with the 96366 and 96367 and when to use which one. My understanding is use 99367 when it is a new substance and 99366 when it is...
  29. T

    96365 for "Teach and Train"

    Our office has patients going home with elastomeric devices for IV antibiotic infusions. The patient comes to our office infusion center to pick up their drugs and supplies and to be taught how to administer these themselves at home. When the patient is being taught they are receiving an...
  30. M

    Chemotherapy Infusions

    New to all of this... I have a patient getting IV benedryl , phenergan and decadron prior to chemotherapy. Each only takes 5 minutes to infuse and it is done throught the same IV site as the chemo. Then patient is infused with one chemo drug for 10 minutes and another chemo drug for 3 hours...