Wiki Infusion Question

[shanamarie]

We have a patient that the nurses are wanting to combine 2 infusion services into one visit. The patient would have IVIG (J1561) run over 2.5-3hours, which is typically billed as 96365/96366. Then they will run Soliris (J1300) immediately afterwards for 1.5 hours, which is typically billed as 96413. I believe this would all be run in the same IV line. My question is how do I go about billing the primary drugs, since they would have different primary codes? I know that I can't use 96365 and 96413 for the service. Would this just be billed as 96365/96366, and 96367? I should also mention this is a physician office infusion center.

 

[thomas7331]

We have a patient that the nurses are wanting to combine 2 infusion services into one visit. The patient would have IVIG (J1561) run over 2.5-3hours, which is typically billed as 96365/96366. Then they will run Soliris (J1300) immediately afterwards for 1.5 hours, which is typically billed as 96413. I believe this would all be run in the same IV line. My question is how do I go about billing the primary drugs, since they would have different primary codes? I know that I can't use 96365 and 96413 for the service. Would this just be billed as 96365/96366, and 96367? I should also mention this is a physician office infusion center.

The instructions for this situation can be found in the infusion section of CPT, after sequential and concurrent infusions are defined. On the facility side, the chemo is always first in the hierarchy, so you would code the 96413 for that and then the 96367/96366 as the sequential for the IVIG. But since your are coding for the physician office and the instructions state that in this setting "the "initial" code that best describes the key or primary reason for the encounter should always be reported irrespective of the order in which the infusions or injections occur" it will depend on which of these drugs is the primary reason for the encounter. If the IVIG meets this definition, then I would code it the way you've suggested here with 96365/96366 and 96367 since I don't believe that the most payers would accept 96417 as an add-on to the 96365 code.