96413 verses 96365

kboyd22

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Can someone explain the difference between 96413 & 96365? We administer infusions of drugs such as Remicade, Actemra and Orencia. We have always been told to bill 96413 to Medicare and 96365 for all other insurance companies, but we are now having some debate about whether we should be using 96413 for all insurance.
 

08pancho

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houston, TX
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if the medication is for Chemotherapy then you should be using 96413 .
96314 description.
The physician or supervised assistant prepares and administers a chemotherapeutic medication to combat malignant neoplasms or microorganisms. These codes describe infusions through catheter tubing placed in a vein. Report 96413 for a single or the initial substance given for up to one hour of service. Report 96415 for each additional hour of service beyond the initial hour.

If the medication is not chemotherapy you should code 96365 with start and stop times.
96365 description
A physician or an assistant under direct physician supervision injects or infuses a therapeutic, prophylactic (preventive), or diagnostic medication other than chemotherapy or other highly complex drugs or biologic agents via intravenous route. Infusions are administered through an intravenous catheter inserted by needle into a patient's vein or by injection or infusion through an existing indwelling intravascular access catheter or port

hope it helps
 
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