Wiki Therapeutic Infusion Queston

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poohbear223

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Good morning! We have been asked the question, "Can you code CPT 96379 for a second therapeutic infusion of the same medication that run less than 31 minutes (i.e. 1-30 minutes)?" In my research, it looks as if CPT 96379 is not an add-on code, so I am not sure that it would be appropriate to code it for the second infusion of the same medication.

Can someone answer this question and help clarify when it would be appropriate to code CPT 96379?
 
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I would not use 96379. Per CPT Assistant, December 2009, an additional infusion less than 30 minutes of the same drug should not be reported:

"Since the third infusion from 1:01 pm-1:15 pm is less than the 30-minute reporting requirement, add-on code 96366, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) would not be additionally reported. "
 
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thomas7331 said:
I would not use 96379. Per CPT Assistant, December 2009, an additional infusion less than 30 minutes of the same drug should not be reported:

"Since the third infusion from 1:01 pm-1:15 pm is less than the 30-minute reporting requirement, add-on code 96366, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) would not be additionally reported. "
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Hello, can you clarify when it would be approriate to use CPT 96379?
 
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CPT Assistant suggests in one article that some payers may recognize 96379 to report an initial hydration infusion of less than 30 minutes, but I have not seen any other guidance for the use of this code. To be honest, I'm not sure what use this code would be since almost all infusions are captured in the existing listed codes. I've coded infusions for a hospital for several years now and never had occasion to use it. As an unlisted code, this would require submission of notes to the payer in order to determine pricing, so my guess would be that the administrative costs of billing this code would outweigh any reimbursement it might bring.
 
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thomas7331 said:
CPT Assistant suggests in one article that some payers may recognize 96379 to report an initial hydration infusion of less than 30 minutes, but I have not seen any other guidance for the use of this code. To be honest, I'm not sure what use this code would be since almost all infusions are captured in the existing listed codes. I've coded infusions for a hospital for several years now and never had occasion to use it. As an unlisted code, this would require submission of notes to the payer in order to determine pricing, so my guess would be that the administrative costs of billing this code would outweigh any reimbursement it might bring.
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Thank you!
 
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poohbear223 said:
Good morning! We have been asked the question, "Can you code CPT 96379 for a second therapeutic infusion of the same medication that run less than 31 minutes (i.e. 1-30 minutes)?" In my research, it looks as if CPT 96379 is not an add-on code, so I am not sure that it would be appropriate to code it for the second infusion of the same medication.

Can someone answer this question and help clarify when it would be appropriate to code CPT 96379?
Click to expand...
The way I understand infusions, you can't repeat the first code because it includes the IV access and tubing, and unless you're starting another IV it's not appropriate. You do charge for the medication though.
 
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How do you handle the coding/billing if there is a second therapeutic infusion of the same medication that run less than 31 minutes (i.e. 1-30 minutes)? Are you coding that time or just billing for the medication and the administration service isn't billed? Thanks!
 
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Check out the guidelines on pages 730-731 to help clarify and code initial, sequential, and concurrent infusions.
When you say "a second therapeutic infusion of the same medication" how much time has elapsed between doses or is one dose given immediately after the other dose? This distinction will decide the coding.
 
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