Wiki Help CPT 96367

[Willow123]

Hello:

We have a member who received a chemotherapy treatment consisting of a therapeutic IV infusion of Dexamethosone (J1100), a therapeutic IV push of Aloxi (J2469) and a chemotherapy IV push of Navelbine (J9390). We billed 96367 for the infusion of J1100 with 20 minute IV run time, a 96375 for the push of J2469 with 1 minute run time, and a 96409 for the Nevalbine with a 10 minute run time. However the 96367 has been denied as not payable.

What code should I have utilized instead of the 96367 and why?

Thank you in advance for your help.

Wendy

 

[ked2505]

96367

I use 96365, Intravenous infusion for therapy, prophylaxis, or dianosis; initial, up to 1 hour.
96367 is a sequential infusion code to 96365.

 

[alannae]

I disagree with Ked2505. I think you billed accurately.

You can only bill one initial code (assuming this is all done in via the same IV/access site). The chemo is the primary reason for treatment so its administration gets the initial code (96409). The code 96365 is an initial code and would only be billable with 96409 if performed through a separate IV site (and documented that way).

Neither of the non-chemo adminstration codes should be initial codes. I would bill 96375 for the 10 minute infusion and the 96367 for the 20 minute infusion just as you did. I think you need to appeal the denial and/or research specific payer requirements/policies.

Good luck!

Alanna