Wiki Multiple IV Pushes for same drug...please help!

[sward23]

We give chemotherapy here in the office and sometimes we bill multiple pushes for the the same drug. Example:

J7070
J1170
J1200
J1885
J2405
96374_59
96375_59 x 7
96361

When we bill this way Medicare has been denying 96375, stating does not support this many services. But if we bill 96375_59 x 6 they pay??? Does anyone know if there is a maximum amt of units we can bill for pushes when given same drug. Does medicare allow provider to report multiple IV pushes of the same drug if rendered in office setting??
What are the guidelines for an office setting since we cannot bill with the multiple push code (hospital code only)?

 

[Stefanie]

Multiple IV pushes for same drug...please help!

This is the exact question my staff and I have been strugging with. We are a family practice group but the scenario is the same...

Time IV was initiated: 9:00am
Fluid Type Bage 1: NS 0.9%
Drip Rate - Bage 1: TKO
Volume Infused - Bag 1: 250cc
Medication 1: Morphine 4mg IVP, 9:10am.
Medication 2: Morphine 4mg IVP, 10:10am (1 hr from Initial Push)
Medication 3: Zofran 4mg IVP, 10:12am

In CPT Guidelines, under the definition of Sequential infusion it says:
"A sequential infusion is an infusion or IV push of a new substance or drug following a primary or initial service. All sequential services require that there be a new substance or drug, except that facilities may report a sequential intravenous push of the same drug using 96376"

I believe this is stating that non-facility sequential IVP's of the same drug can not be reported separately. We have been coding these exactly like your example above, but my research has convinced me that this is incorrect. As of today, I would bill my above example as follows:

96374 (Initial Push of Morphine)
96375 x1 (Zofran)
J2270 x1 (for 8mg of Morphine)
J2405 x 4 (4mg of Zofran)

Do you have anything that would support the additional push for the 2nd morphine push? I have been looking and looking but can't find anything.

Looking forward to your or anyone's prompt response. Thank you!

 

[ollielooya]

I'm following this thread with keen interest. But since the 96376 can't be utilized (only for facility use). we're back to square one concerning the original question.
WHAT code/modifier would be utilized for the 2nd morphine injection in the office setting?

Also, I seem to remember that 96375-59 (7) might be denied for too many units, but it seemed the coding rules and guidelines were again gray as to how many might be allowed. Somewhere there was a thread relating to this issue, but I can't pull it up.....still wondering....Can someone set this straight?
---Suzanne E. Byrum CPC