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coding of IV infusion

  1. Default coding of IV infusion
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    Scenario: Patient received IV infusion of Zofran IV push (96374) and then later received another IV push of the same drug Zofran and we billed 96376 (for each additional sequential IV push of the same substance). Insurance denied because 96376 can only by reported in the facility setting. We are billing for the physician office. What is the correct CPT code to bill the second infusion of the the same drug. Any help would be appreciated. Thanks.

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    Quote Originally Posted by mrolf View Post
    Scenario: Patient received IV infusion of Zofran IV push (96374) and then later received another IV push of the same drug Zofran and we billed 96376 (for each additional sequential IV push of the same substance). Insurance denied because 96376 can only by reported in the facility setting. We are billing for the physician office. What is the correct CPT code to bill the second infusion of the the same drug. Any help would be appreciated. Thanks.
    It would appear in the office setting you would bill the 96374 again with a 59 modifier. It does state in CPT that "96376 may be reported by facilities only".
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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