96365, units, NDC, HELP!!

brandyleigh23

Networker
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Rocky Mount, NC
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Can someone help me with this??

I have been working the "scrubber" the past few months and do not have a background in oncology coding.

The scenario I have is as follows:

Patient notes indicate J1756 injection iron sucrose 200 mg, J7050 normal saline solution 250cc, and 96365 infusion, initial, was performed.This is a Medicare patient.

My question is...Should I be billing 2 units of 96365? This is the way it was keyed but I think there is something missing.
Also, the NDC # was keyed in the claims but why is 20mg listed with the NDC # and 200mg listed under "units" when patient was given 200mg for the J1756?

I am very confused.:confused:
 

skeeley

Networker
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Indianapolis
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Hope this helps

Our consultant has instructed us to bill this as follows. Depending on how this was mixed and given...We mix with the NS and set to run over ____. We bill the J1756 and make sure to indicate the number of units according to the dosage. (ex: 200mg would be 200 units of J1756 since each unit is 1mg)
Then we bill the 96365 for the first hour. (Make sure to check start time/stop time) Some of ours only have the 96365 and no additional hours, but if it does we use 96366 and never more than one unit of 96365. The saline is not billed separately (it is used to mix the iron)
As far as the ndc#, you better check and make sure it belongs to Venofer. Ours is usually the 200mg too.
 

jrs7117

Networker
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Plant City, FL
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Iron infusion

You have to see what the mg/ml is.
We use 200mg/10ml

I believe medicare must be billed in ml.
if I bill for a 1 hour infusion, I use 96365, if it runs over 91 min. I use 96365, 96366.
I bill for 20ml (depending what the pt. receives)

I'm not sure if this will help..
 

trarut

Expert
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Columbus, OH
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a day late, hopefully not a dollar short :)

Hi, Brandy.

96365 is the code for the first hour of a therapeutic infusion; you can only have 1 initial service per day so you should not have multiple units there. (CPT lists the codes that are considered "initial" service codes for drug administration.) You should verify the length of the administration. 96366 is for each additional hour of infusion of the same drug but you must reach 31 minutes to bill the additional time.

From my experience, it sounds like you're getting both the NDC units (based on vial size) and the HCPCS units (used for billing). The HCPCS description for J1756 is iron sucrose 1 mg and the patient received 200 mg so you should bill 200 units.

I also agree with the previous poster who advised to confirm the infusion start/stop times and the drug admin record should show the total quantity of drug used (drug given + waste if any) for confirmation of the units to bill.

Good luck!
 
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