Wiki Injection/Infusion Question

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tfrick2

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I have an I&I question, and I may be overthinking this...

An observation pt had a rocephin infusion on 2/20 from 2255 - 2324 and then 2 more rocephin infusions on 2/21 from 0507 -0537 and 1040 - 1110.

We are trying to figure out how to correctly code the subsequent infusions of the same drug that were not more than 30 minutes. CPT description for 96366 states 30 minutes or more.

They cannot be a push since they were more than 15 minutes.

CPT book section instructions for 96365-96371 has an includes note that states includes an infusion of 16 minutes or more.

CPT Asst Sept 2018 Frequently Asked Questions page 15 - states that second and subsequent infusions should be reported based on the individual times of each additional infusion of the same drug/substance using the appropriate add-on code.

Coding Clinic 2018 Third Qtr gives an example of a patient that has an infusion for 1 hour and 30 minutes. It says that since the additional time does not meet the required 31 minutes or more and it does not meet the requirements of a push, the additional 30 minutes is not coded.

Can you please help us come to a conclusion on how to code the additional infusions?

Thanks so much!
 
I was leaning toward 96367, so I appreciate your input for that. Also thank you for the article; it does help to break out the differences in sequential drug administrations!

Thanks again! :)
 
You're welcome!

I'm pretty new to infusions, but I really like coding them. I was a math major in a former life, and they kind of bring that back to mind in a weird-roundabout-kind of way. :cool:
 
96367 would be incorrect to use in the scenario above because the CPT description -additional sequential infusion of a new drug/substance, up to 1 hour- requires that the sequential infusion be of a different drug from the initial, and in this example the sequential infusion was of the same drug.

I have looked for guidance on the correct way to code this situation when the additional infusion of the same substance is more than the 15 minutes of a push, but less than 30 minutes required for an infusion code, and therefore does not meet the requirements of either code 96366 or 96376. I have not been able to find any definitive answer to the question, but the infusion articles and examples in CPT and CPT Assistant, including the ones cited in the original post, seem to suggest that this is not a billable service. I am not sure that it makes much difference though, in an outpatient facility setting, as the add-on code for the push 96376 is packaged into the rates for the primary procedure and would not result in additional payment in most cases.
 
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