Wiki Help ! 2 Infusions, same day, dif drug

[MLWILLINGHAM]

Infectious Disease -

Patient is being infused with 2 different drugs 4 hours apart - receives the first infusion of TigeCycline (J3243) & Cilastatin (J0743) leaves the office and returns later the same day (3-4 hour rest period) and receives a second infusion of the same drugs.

Medicare is denying second infusion charges as duplicate.

Modifier suggestions?

or do I ...

Do I need to combine total infusion time and only charge one initial (96365) ?

 

[MClarkrn]

Infusion

The first drug is initial the second drug would be additional since they are both on the same day.

 

[OCD_coder]

The second initial service will require a modifier 59, showing that it was a separate "session."

Here is the verbiage from the Medicare IOM.
If more than one ?initial? service code is billed per day, the carrier shall deny the second initial service code unless the patient has to come back for a separately identifiable service on the same day or has two IV lines per protocol. For these separately identifiable services, instruct the physician to report with modifier 59.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

 

[MLWILLINGHAM]

THANK you !!!

The second initial service will require a modifier 59, showing that it was a separate "session."

Here is the verbiage from the Medicare IOM.
If more than one ?initial? service code is billed per day, the carrier shall deny the second initial service code unless the patient has to come back for a separately identifiable service on the same day or has two IV lines per protocol. For these separately identifiable services, instruct the physician to report with modifier 59.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

Thank you, Thank you, Thank you, OCD Coder! Found the manual, found the exact page I needed!