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Cpt 96367

  1. Default Cpt 96367
    Medical Coding Books
    Hi,

    Is a 76 modifier needed when there is more than one billable unit for 96367?

  2. #2
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    A modifier isn't needed- just bill 96367 x 2. Once in a while we run into a payer that will deny for no valid reason but always have gotten it paid on appeal.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  3. Default 96367
    Our system flags it as edits. I've seen 2 units billed with no problem but we have 3 units billed and a -76 modifier was added and separated on one line with 1 unit each

    96367-76 1 unit
    96367 -76 1 unit
    96367-76 1 unit

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
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    you do not use the 76 modifier as it is not a repeated service. to be repeated it must be the same service repeated in a different setting.
    Sequential Infusion Definition :
    Initiation of different drug administered immediately following the initial infusion
    Note this is not exactly a true definition since sequential can refer to something that is administered “before or after”
    Report once per encounter for the same infusate mix;
    Note additional hours will be reported by using the therapeutic add'l hour infusion code ( 2010 CPT 96366)

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    If the 76 wasn't manually added by someone and separated out into 3 line items maybe its an IT issue. Maybe the settings in your system dont allow for 96367 x 3? I would check with your IT person to take a look at it and adjust the settings.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
    Default
    IF you had three different sequential infusates then you would use the 59 modifier not the 76 and not units. you will note the book states up to 1 hour, and it can be reported only once for the sequential infusion of the same infusate, so one unit only
    so then 3 different infusates as sequential
    96367
    96367 59
    96367 59
    but you need a different infusate billed with the initial 96365 or and initial push or some other initial service first listed.

    Debra A. Mitchell, MSPH, CPC-H

  7. Smile mhindson1956@att.net
    hello ladies/gents, i have trying to understand this code for 2 hours now can some one please give me an example of when you would code a 96365 and then 2 or 3 96367 codes.

    I had a rocephin for my initial which i coded a 96365 from lets say 1-2 or one hour, then form 201 until 2:40 i had lets say vicodin running and then at 2:41 until 3:30 was magnesium sulfate so i coded it as 96365, 96367x2 how would you ladies/gentlemen have coded this example and it was running out of of line? thanks for any help on this, i understand the 96368 but am having big problems understanding the 96367 concept thanks

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
    Default
    you have:
    96465 for the initial infusion of the rocephin with 1 unit
    96367 for the vicodin with 1 unit
    96367 59 for the additional sequential infusion of the mag sulfate. with 1 unit
    the instruction states to code the 96367 only once for each sequential infusion of a different drug. you can nnot report units greater than 1 for 96367. for each additional hour of the same drug of 96367 you add on the 96366.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default
    Quote Originally Posted by mhindson View Post
    hello ladies/gents, i have trying to understand this code for 2 hours now can some one please give me an example of when you would code a 96365 and then 2 or 3 96367 codes.

    I had a rocephin for my initial which i coded a 96365 from lets say 1-2 or one hour, then form 201 until 2:40 i had lets say vicodin running and then at 2:41 until 3:30 was magnesium sulfate so i coded it as 96365, 96367x2 how would you ladies/gentlemen have coded this example and it was running out of of line? thanks for any help on this, i understand the 96368 but am having big problems understanding the 96367 concept thanks
    MHINDSON -
    I agree with you. The 96365 & 96367x2 would be the way to go. Good luck!

  10. #10
    Location
    Columbia, MO
    Posts
    12,531
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

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