Wiki Help with infusion codes

[priceless]

Toradol- 15mg- 4:20 to 4:20 IV push
Zofran- 4mg, - 4:20 to 4:22 IV push
Toradol- 15mg - 5:57 to 5:57 IV push

I coded the following.
96374- initial IVP for Toradol
96375*2- additional IVP for Zofran and Toradol

We are physician group, not facility.
So per cpt, I cannot bill 96376.

My question is can I bill 96375*2 for the additional Toradol administration?

Thanks

 

[thomas7331]

You cannot bill two units of 96375 in this case. Per the CPT description, 96375 is for "each additional sequential intravenous push of a new substance/drug" and since the drug administered in the second unit (Toradol) is not new, it does not meet the definition in order to bill that code.

 

[melody.roth@regence.com]

Infusion and IV Push Coding

For professional billing Infusions and IV push, should the infusate code be billed in addition to the infusion code?

For Hospital Outpatient facility billing Infusions, IV push, should the infusate code be billed in addition to the infusion code?

What are the guidelines for billing the infusate if the Patient supplies/brings it to the infusion suite/OP Hospital/Office setting?

An additional question - Facility claim is billing infusion codes 96365, 96366, P9016 RBC Leukocytes x2, 36430 blood transfusion. Should a blood transfusion be billed with 36430 and P9016 only? Or is it appropriate to also bill 96365, 96366.

Can you provide a reference for me?
Thanks for your assistance.

 

[thomas7331]

For professional billing Infusions and IV push, should the infusate code be billed in addition to the infusion code?
For Hospital Outpatient facility billing Infusions, IV push, should the infusate code be billed in addition to the infusion code?

Yes, the cost the drugs administered is not included in the reimbursement for the administration itself, and the substances infused must be identified. Medicare and other payers, depending on their reimbursement methodologies, may 'package' some low-cost drugs into their payment for infusions, but the substances still should be reported so that correct benefits will be applied.

What are the guidelines for billing the infusate if the Patient supplies/brings it to the infusion suite/OP Hospital/Office setting?

I'm not aware of official guidelines for this, but standard practice is to bill the drugs with a $0 or $0.01 charge so that the substance infused is identified but the charge represents that there was no cost incurred by the billing provider since the drug was paid for by the patient or their pharmacy benefit.

An additional question - Facility claim is billing infusion codes 96365, 96366, P9016 RBC Leukocytes x2, 36430 blood transfusion. Should a blood transfusion be billed with 36430 and P9016 only? Or is it appropriate to also bill 96365, 96366.

Blood transfusions and IV infusions are two distinct services - you would not report 96365/96366 for blood transfusions, but you could report these codes if a separately identifiable infusion unrelated to the transfusion was performed at the same encounter. Per CPT instructions, "Do not report 96365-96379 with codes for which IV push or infusion is an inherent part of the procedure."