Physician Infusion Services, CHONC Practice Exam Clarification.

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Anchorage, Alaska
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Hello,

I was hoping for clarification on a topic that has me torn as to the true and correct coding method. The below scenario and rationale comes directly from the CHONC Specialty Practice Exam.

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Prior to this I have previously been taught that we can only bill a IV push as primary to a hydration infusion (Facility Hierarchy rules), but per the AAPC rationale provided because I am in a physician practice (not a facility) I can bill a 96360 and 96375 in a real life scenario.

Has anyone ever tried this? Or do hey have any experience with physician infusion guidelines being different than facility guidelines?

The AMA CPT Guidelines for hydration and therapeutic infusions do state that “When these codes are reported by the physician or other qualified healthcare professional, 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 of injects occur.”


Any input is greatly appreciated!!

Thank you,
Asia
 
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Daytona beach, FL
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Below is the rationale provided to me for the above question, stating that I can bill a 96360 with 96375 as a physician practice....

View attachment 3521
I have been scouring the internet and all the resources I can find for an answer to this question so thank you! I also do coding in a physician setting and the primary reason of the visit many times is hydration therapy but they also provide IVPs of drugs that are necessary.

Since we can only use 1 initial code and the parenthetical notes do not state 96375 (add-on code) can be used in conjunction with 96360 as the initial service it leads me to feeling forced to use 96374 as the initial code with 96361 to report the hydration time(using the hierarchy guidelines that facilities would use) but I do not feel comfortable doing this when the drug push administered is not the primary reason for service over hydration.

I am really curious, do you mind telling me if you have started billing them with the 96360-96375, have these been coming back paid/without denials?
 

dtricia

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using 96375 as add on to hydration

My CPT book says 96375 is add on only to 96365, 96374, 96409,96413. it should not be added on to hydration.

I was always taught that the therapeutic drugs outranked hydration and that code would be be primary to hydration and I billed it that way.

Per CPT for physician billing or other qualified health care professional reporting , an initial infusion is the Key or primary reason for the encounter reported irrespective of the temporal order in which the infusion (s) or injections are administered.
For facility reporting, an initial infusion is based using the hierarchy.
This is in the CPT book.
Tricia D
 
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My CPT book says 96375 is add on only to 96365, 96374, 96409,96413. it should not be added on to hydration.

I was always taught that the therapeutic drugs outranked hydration and that code would be be primary to hydration and I billed it that way.

Per CPT for physician billing or other qualified health care professional reporting , an initial infusion is the Key or primary reason for the encounter reported irrespective of the temporal order in which the infusion (s) or injections are administered.
For facility reporting, an initial infusion is based using the hierarchy.
This is in the CPT book.
Tricia D
Thanks for your response. I am still not sure about this unfortunately. For example, if the main reason the patient comes in is for severe dehydration and they are given intravenous hydration but also are given an IVP of say toradol due to the patient developing a headache (This may not be realistic. Just an example). The primary reason for the visit regardless of the order of administration is still the (96360) I.V. hydration and the add-on SHOULD be the (96375) New I.V. Push but the difficulty is as you stated that guidelines do not specify this add-on code may be added with hydration, so regardless of the primary reason for the visit you are basically still forced to report the IVP primary (96374) with the (96361) secondary to report the hydration time. Of course, this is strictly an issue I have due to being non-facility reporting otherwise the hierarchy of facility reporting would change the circumstances.
 
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