Wiki Infusion admin 96365 / possible reaction

[DGray]

Looking for assistance with 96365. Infusion started and then stopped at 3minute mark due to patient condition. May we still bill the 96365 with a 52 modifier? Patient was continually monitored for almost an hour before discharge. Any guidance will be appreciated.

Thanks,
Donna

 

[thomas7331]

Per CPT instructions, an infusion of 15 minutes or less is classified as a push, so I would report 96374 rather than using the modifier.

 

[DGray]

Per CPT instructions, an infusion of 15 minutes or less is classified as a push, so I would report 96374 rather than using the modifier.

Thank you. I thought of using 96374 but second guessed myself due to the time spent with patient.

 

[thomas7331]

Thank you. I thought of using 96374 but second guessed myself due to the time spent with patient.

If this took place in a physician office and there was an E&M service performed during the same encounter, you may be able to code 99415 for the prolonged clinical staff time. But if this is a facility or infusion center charge, then I'm not sure there is anything that can be coded for the monitoring time.