Wiki Help Medicare denying 96361

[clomija2@gmail.com]

Is anyone having this problem???? Medicare (palmetto JB1) eff 04/29/2013 is denying all our claims that have 96361 without 96360. We do a lot of IV drug infusion (96365) and IV hydration. Are normal sequencing is 96365 (primary) with drugs then 963361 (add on) with lactated ringers. Medicare is telling me that I need the 96360? I advised her that we have billed it that way before and 96360 denied inclusive to the 96365 because we cannot have two primary codes. that is why we use the 96361. she will send it up for review. I am trying to find out is their was a change in guidelines, but everything I read states that I cannot have two prime codes in one claim???? HELLLPPPP if you know anything else

 

[bedwards]

96361 is an add on code designated with the plus sign in the code book. It also references to use it in addition to 96360. You need to account for the initial time since 96361 states "each additional hour".

Below is from CPT:

96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour

(Do not report 96360 if performed as a concurrent infusion service)

(Do not report intravenous infusion for hydration of 30 minutes or less)

+96361 each additional hour (List separately in addition to code for primary procedure)

(Use 96361 in conjunction with 96360)

(Report 96361 for hydration infusion intervals of greater than 30 minutes beyond hour increments)

(Report 96361 to identify hydration if provided as a secondary or subsequent service after a different initial service [96360, 96365, 96374, 96409, 96413] is administered through the same IV access

 

[hmassimino]

I'm seeing this as a recent MCR change, which doesn't make sense to me. It says right in the CPT that 96361 can be used with 96374. I code infusions daily and have always used the 96361 with 96374.

The Feb 2013 issue of Coding Edge states:
CPT® Code CPT® Description Notes
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour
Do not report if performed as concurrent infusion service; do not report hydration infusion of 30 minutes or less).
Use for infusions of 31-90 minutes.
96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
Report for intervals of greater than 30 minutes beyond one-hour increments;
also report for secondary or subsequent service after a different initial service

Also this link also states that 96361 can be billed with 96374, reference page 14 and 16
http://www.ndhima.org/resources/SRoehl+Mastering+Injections+and+Infusions+NDHIMA+0412.pdf

I can't find any documentation from MCR stating the change. Any help would be appreciated.