Wiki Infusion Coding


Medina, Tennessee
Best answers
I am a new coder at a billing office and one of our physicians has a question about billing a Medicare patient for an infusion. This is what she sent me.

I have a patient who has cancer and would like to receive Vitamin C IV infusions with us. Medicare will cover the IV part, but not the vitamin C. The patient said that at his other doctor's office, when he had his knee injected they billed his insurance for the injection, but he had to pay out of pocket for the medication. Can we legally do that in this situation?

Place Needle In Vein 36000

Office/outpatient Visit Est 99213 1 UN
Normal Saline Solution Infus J7030 1 UN
Hydration Iv Infusion Init 96360

This is how she is wanting to bill the encounter and the infusion.

Just need some input as I have done some research and another experienced coder has as well with no definitive answer.
If anyone is familiar with infusion coding can you please help me out!
If the pt is receiving an infusion depending on the time 16+min you would report the IVPB 96365, less than 15 min IVP 96374 and unless there is documentation of medical necessity or some sign or symptom that would require hydration you wouldn't report 96360; if there was you would have to carve out the hydration from the infusion time and then you could report the 96361 in addition.