Wiki BILLING 96374 WITH 96413 AND 96365

[mmathewscpc]

i have read recently in the coding book for the 96374 code, that it is for short infusions, less than 15 minutes. my question is that when i bill my infusions with the admin codes to commercial as such: 96413, 96415, J code, 96374-59. uhc denies it as incorrect, and other insurances pay on the code and some deny. i also believe that it takes longer to process these claims due to billing that 96374 right?

 

[dlpirtle]

You cannot bill 96374 with 96413 as they are initial codes per the AMA guidelines, you would need to bill 96375 with the 96413.

 

[mmathewscpc]

ok, 96413 and 96365 are initial infusion hour codes, 96374 is initial push of medication in an infusion, not the first hour....and 96375 is an add on code, it's the additional push of same or different medication in the same infusion. I wanted to know if you can bill the 96374 in an infusion that is 2 hours long, and with a j code, which is not a push medication, and there is no other medication used in this infusion.

 

[simqueen]

ok, 96413 and 96365 are initial infusion hour codes, 96374 is initial push of medication in an infusion, not the first hour....and 96375 is an add on code, it's the additional push of same or different medication in the same infusion. I wanted to know if you can bill the 96374 in an infusion that is 2 hours long, and with a j code, which is not a push medication, and there is no other medication used in this infusion.

CPT guidelines note that if you have one IV site, you can only have one initial service. So, if you have 96413 or 96365 for an infusion, 96374 is off the table for that scenario. Because it is an initial code also, and you only have one IV site and one initial service. So, for your infusion that is less than 15 minutes, and your chemo or therapeutic infusion that is reported for an infusion, 96375 is reported for the less than 15 minute infusion.

 

[mmathewscpc]

CPT guidelines note that if you have one IV site, you can only have one initial service. So, if you have 96413 or 96365 for an infusion, 96374 is off the table for that scenario. Because it is an initial code also, and you only have one IV site and one initial service. So, for your infusion that is less than 15 minutes, and your chemo or therapeutic infusion that is reported for an infusion, 96375 is reported for the less than 15 minute infusion.

right, i've been trying to tell my manager, that 96374 should not be billed with my j code, since it's an hour long infusion, the 96375 does not belong in that equation at all. he gave the ok to stop billing it so i'm happy.