Results 1 to 4 of 4

Ketamine infusion for RSD

  1. Default Ketamine infusion for RSD
    Medical Coding Books
    I am researching Ketamine infusion for pain management of patients with RSD. Usually this is infused over several days; may take a few hours to infuse. Would it be appropriate to bill IV infusion? Possibly 96365 + add-ons as appropriate. Plus the appropriate J code for the Ketamine. My question, is this a billable and payable service to insurances with this diagnosis and use of Ketamine? I am in the early stages of research, so any guidance as to where to start would be helpful. I have researched "Ketamine" in my local Medicare carrier's medical policies, but none appeared. I know all services have to meet medical necessity. How do I determine if Ketamine is appropriate to be used and administered in this way? My gut says that if there is no support for its use in that manner, then the service may not fly as medically necessary. And while Medicare may initially pay for IV infusion, after a review, it may not meet the medical necessity requirement and then be revoked. I want to avoid RACs and any other letter combinations as much as possible!

  2. #2
    Denver Colorado
    Often the Ketamine infusion is performed in a facility setting rather than a physician office which means that the IV infusion codes are not billable by the physician. See the CPT section guidelines for the 9636X codes. If performed in a facility setting, the documentation may support an E/M code but the physician would need to have a face-to-face service & documentation, etc.

  3. Default to follow up on Ketamine infusion
    What if it is done in an office setting? How does that work for billing purposes if an infusion nurse performs the service and monitors the patient? We do not currently perform many services in our own office, other than OMT and some acupuncture that the physician performs himself. We do not have any other types of providers (nursing, etc.) that might create incident-to or other billing scenarios. We understand that this opens a whole new world for staffing, billing, coding, etc. that we haven't directly dealt with in the past. Does the infusion of Ketamine change what type of place of service we would need to be?

  4. #4
    Thank you!!

Similar Threads

  1. Ketamine Infusion
    By karras in forum Anesthesia
    Replies: 4
    Last Post: 07-10-2014, 12:55 PM
  2. Ketamine Therapy
    By gatewayclinic in forum Family Practice
    Replies: 0
    Last Post: 03-01-2012, 12:14 PM
  3. Ketamine hydrochloride
    By ANDREAHSANCHEZ in forum Auditing General Discussion
    Replies: 1
    Last Post: 10-26-2011, 04:31 PM
  4. Ketamine Infusion
    By BJTRAISTER in forum Anesthesia
    Replies: 2
    Last Post: 10-05-2010, 11:33 PM
  5. Help please....with RSD
    By LTibbetts in forum Diagnosis Coding
    Replies: 2
    Last Post: 06-26-2009, 11:35 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.