Cpt 96367

relong

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A modifier isn't needed- just bill 96367 x 2. Once in a while we run into a payer that will deny for no valid reason but always have gotten it paid on appeal.
 
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96367

Our system flags it as edits. I've seen 2 units billed with no problem but we have 3 units billed and a -76 modifier was added and separated on one line with 1 unit each

96367-76 1 unit
96367 -76 1 unit
96367-76 1 unit
 

mitchellde

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you do not use the 76 modifier as it is not a repeated service. to be repeated it must be the same service repeated in a different setting.
Sequential Infusion Definition :
Initiation of different drug administered immediately following the initial infusion
Note this is not exactly a true definition since sequential can refer to something that is administered “before or after”
Report once per encounter for the same infusate mix;
Note additional hours will be reported by using the therapeutic add'l hour infusion code ( 2010 CPT 96366)
 

relong

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If the 76 wasn't manually added by someone and separated out into 3 line items maybe its an IT issue. Maybe the settings in your system dont allow for 96367 x 3? I would check with your IT person to take a look at it and adjust the settings.
 

mitchellde

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IF you had three different sequential infusates then you would use the 59 modifier not the 76 and not units. you will note the book states up to 1 hour, and it can be reported only once for the sequential infusion of the same infusate, so one unit only
so then 3 different infusates as sequential
96367
96367 59
96367 59
but you need a different infusate billed with the initial 96365 or and initial push or some other initial service first listed.
 

mhindson

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mhindson1956@att.net

hello ladies/gents, i have trying to understand this code for 2 hours now can some one please give me an example of when you would code a 96365 and then 2 or 3 96367 codes.

I had a rocephin for my initial which i coded a 96365 from lets say 1-2 or one hour, then form 201 until 2:40 i had lets say vicodin running and then at 2:41 until 3:30 was magnesium sulfate so i coded it as 96365, 96367x2 how would you ladies/gentlemen have coded this example and it was running out of of line? thanks for any help on this, i understand the 96368 but am having big problems understanding the 96367 concept thanks
 

mitchellde

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you have:
96465 for the initial infusion of the rocephin with 1 unit
96367 for the vicodin with 1 unit
96367 59 for the additional sequential infusion of the mag sulfate. with 1 unit
the instruction states to code the 96367 only once for each sequential infusion of a different drug. you can nnot report units greater than 1 for 96367. for each additional hour of the same drug of 96367 you add on the 96366.
 

hnroberts

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hello ladies/gents, i have trying to understand this code for 2 hours now can some one please give me an example of when you would code a 96365 and then 2 or 3 96367 codes.

I had a rocephin for my initial which i coded a 96365 from lets say 1-2 or one hour, then form 201 until 2:40 i had lets say vicodin running and then at 2:41 until 3:30 was magnesium sulfate so i coded it as 96365, 96367x2 how would you ladies/gentlemen have coded this example and it was running out of of line? thanks for any help on this, i understand the 96368 but am having big problems understanding the 96367 concept thanks
MHINDSON -
I agree with you. The 96365 & 96367x2 would be the way to go. Good luck!
 

mitchellde

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I am curious as to why you would use 2 units for the 96367 when the instructions clearly state that it may be coded only once per drug. Using 2 units will likely cause a denial for units out of range. I am just wondering why you would suggest that this is the way to do this.
 

hnroberts

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I am curious as to why you would use 2 units for the 96367 when the instructions clearly state that it may be coded only once per drug. Using 2 units will likely cause a denial for units out of range. I am just wondering why you would suggest that this is the way to do this.
Mitchellde~
You are correct that the instructions state that the 96367 may be coded only once per drug. There were, however, two seperate additional drugs given. One 96367 for the vicoden and one 96367 for the magnesium sulfate. I believe it is unnecessary to code two seperate lines of 96367 one without a modifier and one with. It is redundant in my opinion.
I reccommended the scenario be coded wtih the 96365 & 96367 x2 because that is how NCCI edits have cleared the coding. Chemotherapy and non-chemotherapy audits that have been done on our charts have coded the administration this way as well.
I appreciate your perspective and professional opinion, but I choose to respectfully disagree with your recommendation of 96365, 96367, & 96367-59. I hope that if you disagree with my professional opinion, we can then agree to disagree.
 
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mitchellde

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I do disagree. As billing 2 units does not indicate 2 different drugs using 2 line items with a 59 does by definition indicate a distinc and separate substance. Units are suppose to be used for procedures or services that come as quantity distributions. This one does not. Timed services and the J codes for the drugs come distributed in quantities so it is natural to bill these with units. So I do disagree with how you are saying to bill this code.
 

hnroberts

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I do disagree. As billing 2 units does not indicate 2 different drugs using 2 line items with a 59 does by definition indicate a distinc and separate substance. Units are suppose to be used for procedures or services that come as quantity distributions. This one does not. Timed services and the J codes for the drugs come distributed in quantities so it is natural to bill these with units. So I do disagree with how you are saying to bill this code.
Mitchellde-
I'm interested in taking a look at the documentation you have that backs up your response. If our auditors are doing something wrong, I would like to bring it to their attention and learn something new as well. I appreciate your perspective.
 

relong

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Submitting a claim for 96367 i.e.
96367
96367, 59
96367, 59

This would deny for either duplicate or invalid modifier. CPT does not specify that a modifier is required for multiple use of this code, only that it may be used only once per infusate mix. When the claim is submitted it should be submitted at the same time as the drug(s) being administered.

I would submit this code as 96367 x 3

The only denials I've ever had for this was when a payer questioned whether a drug could have been administered as IVP vs. infusion. In which case once the FDA approved package insert recommendations for administration was submitted the claim was paid.
 

katelliott80

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I agree with the 96367x2 answer. I am taking the CHONC test this weekend and my study guide and Online Practice test have answers with multiple units of 96367.

They are not seperated out with mod 59, like answers with 96372-59.
 

latnguy805

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Rituxan is given for 3 hours from 12:00 pm to 3:00 pm. Aloxi and Decadron are mixed in one bag and infused for 20 minutes from 3:00 pm to 3:20 pm. Benadryl and Zantac are mixed in one bag and infused for 20 minutes from 3:20 pm to 3:40 pm.

How would you code this?

96413
96415x2
96367 (x1 or x2?)

I thought for 96367, we had to add the infusion times together and then bill accordingly.

We have to bill 96367 for each separate infusion?

What if the Benadryl and Zactac took an hour and 35 minutes to infuse?
 
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