96367 x 4

TFlohr

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With chemo 96413 I have 4 separate infusions 96367 (decadron, benadryl, zofran and iron), each documented 20 minutes to 1 hour. Since CPT code 96367 "revised" in 2012, Medicare now only allows payment on 3. Is there a new coding rule on this? Should I appeal this with Medicare? Should nursing staff adjust infusion times to bill 96375 instead?
 

ollielooya

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I surely hope someone will answer this for you, as I did read about an adjustment made to allow for more then 3 units due to protests by oncologists and other groups and that the limit of 3 has been "relaxed" to allow for more, but unfortunately I do NOT have the report to back this up. You might want to perform a "search" using this particular code on the forum and see if it pops up somewhere. Definitely worth investigating and waiting for an answer. ---Suzanne E. Byrum CPC
 

TFlohr

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You are correct, and Thank You for your suggestion. I researched this through COA and found the MUE was changed. :)
 
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