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Wiki 96411 and Humana

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LKaf7

Networker
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Parma, OH
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Hello,

I am working on a Medical Record Review Dispute and Humana does not agree with our use of 96411. I'm assuming this is because the nurse documented 17 minutes for this. This medication was ordered to be infused over 10 minutes, however due to an overfill with the solution and the rate not being adjusted, it took a few minutes longer. I do not feel comfortable upping the code. Any ideas how to handle this appeal? Its rare to having a payer dispute a charge that I guess technically based on guidelines should be higher.
 
Infusion time is not determined by the order and any number of factors can influence the actual administration time. Could the volume could have been safely given in less than 15 minutes? Possibly not. If the medication was documented as given over 17 minutes, bill it as an infusion.
 
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