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96374 versus 96375

  1. Talking 96374 versus 96375
    Medical Coding Books
    Hi, Question

    There can only be one initial code billed on the same day correct here is what codes are being billed

    non chemo
    pt received 3 ivp, 1 ivmb, 1 hr of hydration dx 346.90, Done in location 20
    96365 x1 time medication infused 1802-1850
    96361 x1
    96374 x1
    96375 x2
    94760
    99215-25

    Please advise thanks

  2. Default
    Quote Originally Posted by adecker View Post
    Hi, Question

    There can only be one initial code billed on the same day correct here is what codes are being billed

    non chemo
    pt received 3 ivp, 1 ivmb, 1 hr of hydration dx 346.90, Done in location 20
    96365 x1 time medication infused 1802-1850
    96361 x1
    96374 x1
    96375 x2
    94760
    99215-25

    Please advise thanks
    it should be 96365; 96375 x3; 96361

  3. #3
    Location
    Columbia, MO
    Posts
    12,841
    Default
    It would really help to have more information. The reason for the visit, and the reason for the medications. You can have only one initial but it is hard to tell from this which one should be initial.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Quote Originally Posted by mitchellde View Post
    It would really help to have more information. The reason for the visit, and the reason for the medications. You can have only one initial but it is hard to tell from this which one should be initial.
    It doesnt change. It is always chemo, infusion, pushes, hydration.

  5. #5
    Location
    Columbia, MO
    Posts
    12,841
    Default
    Not necessarily. If you are coding for the physician the initial code goes to the code for the reason for the encounter. Per CPT:
    According to CPT for facility coding chemotherapy services are primary to theraputic, prophylactic and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. Hydration codes are facility reporting only. For physician reporting initial code that best describes the primary reason for the encounter should be reported irrespective of the order in which the infusions or injections occur. So the documentation will determine which gets the inital code for the physician.

    Debra A. Mitchell, MSPH, CPC-H

  6. Question 96374 versus 96365
    Good Morning, this patient was seen in Urgent Care for gastritis and abdominal pain. I am billing for the physicians not facility and this is NOT for Chemo infusions.. I just wanted to make sure that only 1 initial code is allowed and I was curious as I coded as

    pt had 3 doses of morphine ivp and minibag of zantac and iv fluids in UC setting (20 pos) Thanks

    96365 x1 IV minibag initial (zantac)
    96375 x1 new drug IVP addtl (morphine 4mg first push)
    96376 x2 same drug IVP addtl (morphine same drug pushed addtl 2 times)
    96361 x1 IV hydration 1550-1655
    99204-25

  7. #7
    Location
    Columbia, MO
    Posts
    12,841
    Default
    96376 is facility reporting only, not for physicians. 96375 is for the additional but can be reported only one time for the same drug. so it looks like you would have
    96365 x1
    96775 x1
    96561 x1
    99204 - 25

    Debra A. Mitchell, MSPH, CPC-H

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