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Cpt 96367

  1. #11
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    Quote Originally Posted by mitchellde View Post
    I am curious as to why you would use 2 units for the 96367 when the instructions clearly state that it may be coded only once per drug. Using 2 units will likely cause a denial for units out of range. I am just wondering why you would suggest that this is the way to do this.
    Mitchellde~
    You are correct that the instructions state that the 96367 may be coded only once per drug. There were, however, two seperate additional drugs given. One 96367 for the vicoden and one 96367 for the magnesium sulfate. I believe it is unnecessary to code two seperate lines of 96367 one without a modifier and one with. It is redundant in my opinion.
    I reccommended the scenario be coded wtih the 96365 & 96367 x2 because that is how NCCI edits have cleared the coding. Chemotherapy and non-chemotherapy audits that have been done on our charts have coded the administration this way as well.
    I appreciate your perspective and professional opinion, but I choose to respectfully disagree with your recommendation of 96365, 96367, & 96367-59. I hope that if you disagree with my professional opinion, we can then agree to disagree.
    Last edited by hnroberts; 05-05-2011 at 04:55 PM.

  2. #12
    Location
    Columbia, MO
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    I do disagree. As billing 2 units does not indicate 2 different drugs using 2 line items with a 59 does by definition indicate a distinc and separate substance. Units are suppose to be used for procedures or services that come as quantity distributions. This one does not. Timed services and the J codes for the drugs come distributed in quantities so it is natural to bill these with units. So I do disagree with how you are saying to bill this code.

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
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    Quote Originally Posted by mitchellde View Post
    I do disagree. As billing 2 units does not indicate 2 different drugs using 2 line items with a 59 does by definition indicate a distinc and separate substance. Units are suppose to be used for procedures or services that come as quantity distributions. This one does not. Timed services and the J codes for the drugs come distributed in quantities so it is natural to bill these with units. So I do disagree with how you are saying to bill this code.
    Mitchellde-
    I'm interested in taking a look at the documentation you have that backs up your response. If our auditors are doing something wrong, I would like to bring it to their attention and learn something new as well. I appreciate your perspective.

  4. #14
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    Bettendorf, Iowa
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    Submitting a claim for 96367 i.e.
    96367
    96367, 59
    96367, 59

    This would deny for either duplicate or invalid modifier. CPT does not specify that a modifier is required for multiple use of this code, only that it may be used only once per infusate mix. When the claim is submitted it should be submitted at the same time as the drug(s) being administered.

    I would submit this code as 96367 x 3

    The only denials I've ever had for this was when a payer questioned whether a drug could have been administered as IVP vs. infusion. In which case once the FDA approved package insert recommendations for administration was submitted the claim was paid.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  5. #15
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    I agree with the 96367x2 answer. I am taking the CHONC test this weekend and my study guide and Online Practice test have answers with multiple units of 96367.

    They are not seperated out with mod 59, like answers with 96372-59.

  6. Default
    No mod on 96367.
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

  7. Default
    Rituxan is given for 3 hours from 12:00 pm to 3:00 pm. Aloxi and Decadron are mixed in one bag and infused for 20 minutes from 3:00 pm to 3:20 pm. Benadryl and Zantac are mixed in one bag and infused for 20 minutes from 3:20 pm to 3:40 pm.

    How would you code this?

    96413
    96415x2
    96367 (x1 or x2?)

    I thought for 96367, we had to add the infusion times together and then bill accordingly.

    We have to bill 96367 for each separate infusion?

    What if the Benadryl and Zactac took an hour and 35 minutes to infuse?
    Last edited by latnguy805; 07-07-2011 at 02:05 PM.

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