Question Infusions Coding, 96368 and 96367 or 96366?

jvroman1

New
Messages
2
Best answers
0
I have a questions regarding the use of infusion codes 96368 with either 96367 or 96366, same drug.

These are all in the same site: I have an infusion of Vanco running from 1 pm to 3 pm. (96365 and 96366) Then I have Maxipime running from 2 pm to 2:40 pm which is concurrent (96368). Then they run the Maxipime again four hours later from 6 pm to 7 pm. I've been told I can't code this with a 96366 or a 96367 if it's the same drug as the 96368. If it were a different drug (Ancef for instance) I could code the 96367 but nothing for the same drug. Does anyone know the logic behind this? Thanks!
 

cgontarz

New
Messages
3
Best answers
0
states use 96366.

But if the same drug is given multiple times, then use 96366, the additional hours code associated with the sequential therapeutic infusion. The additional hours code 96366 is now used to report multiple services, including the following:
  • Additional hours of the initial service infusion
  • Additional hours of a sequential infusion, which means additional hours of an infusion of a new drug
  • Additional infusions of the same substance or drug
Coders can report 96366 (intravenous infusion, therapy, prophylaxis, or diagnosis; each additional hour) for additional hours of the initial infusion. For a sequential infusion of a new drug, coders should report 96367 (intravenous infusion, therapy, prophylaxis, or diagnosis; additional sequential infusion, [list separately in addition to code for primary procedure] up to one hour).
 

trarut

Guru
Messages
183
Location
Columbus, OH
Best answers
0
Assuming the second dose of Maxipime is a completely separate and new infusion encounter, I would use 96365 with a 59 or XE if the payer accepts it. If the Maxipime was given a second time sequentially during the same infusion encounter, I'd use 96367 because it's a different method of administration. If it was given concurrently again during the same encounter, no additional administration would be billable since 96368 can only be billed once per day. Note: I am a pro-fee biller, not a facility biller so facility rules may be different.
 
Top