Wiki 96365 Mod needed ???

[alderego002]

Hi,
We hardly use 96365. It's actually been a while. The Dr performed this in office with an Oral I&D. The claim was denied as included with service provided. Should I be using a modifier??

 

[thomas7331]

If the infusion was part of the procedure (e.g. it was for administration of anesthesia or other medications that were an integral part of the procedure), then it is considered bundled and 96365 should not be reported.

 

[alderego002]

Thank you...The infusion was actually antibiotic Tx. Not used for anesth. Would I need a mod??

 

[thomas7331]

Thank you...The infusion was actually antibiotic Tx. Not used for anesth. Would I need a mod??

If the antibiotic infusion is completely unrelated to the procedure - i.e. done at a separate time or encounter and/or for treatment of a different condition or problem than, then yes, a modifier (e.g. XE, XU, 59, etc.) would be appropriate. But if this is for antibiotics that are given during the procedure or as a component of the surgery, then no. Antibiotics routinely administered as part of a surgical procedure to prevent infections are incidental to the procedure itself and wouldn't support the use of a modifier.

Per the NCCI manual:
The global surgical package includes the administration of fluids and drugs during the operative procedure. CPT codes 96360-96377 shall not be reported separately for that operative procedure. Under OPPS, the administration of fluids and drugs during or for an operative procedure are included services and are not separately reportable (e.g., CPT codes 96360-96377).