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IV Physician coding

  1. #11
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    Shoals Area Professional Coders
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    Medical Coding Books
    Per CPT GUIDELINES you would bill 96365 fro the rocephin time given next you would bill J0696 (HCPC) code for the drug given bill the number of milligrams for rocephin. Next you would per CPT GUIDELINES "report 96361 to identify hydration if provided as a second or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access!
    Ex:
    96365 initial up to one hour
    J0696 Rocephin 250 mg
    96361 Each additional hour

    I hope this helps! I've billed these type of treatments along with chemo treatments for over seven years

  2. #12
    Location
    Tacoma, WA
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    Quote Originally Posted by dmtaylor98 View Post
    Per CPT GUIDELINES you would bill 96365 fro the rocephin time given next you would bill J0696 (HCPC) code for the drug given bill the number of milligrams for rocephin. Next you would per CPT GUIDELINES "report 96361 to identify hydration if provided as a second or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access!
    Ex:
    96365 initial up to one hour
    J0696 Rocephin 250 mg
    96361 Each additional hour

    I hope this helps! I've billed these type of treatments along with chemo treatments for over seven years
    Thank you, it does help to get clarification from someone who actually uses the codes! I am learning so much from the forums these days!

  3. Default
    I know that you can bill 96376 (same drug) only if 30 minutes has elapsed. My question is can you bill 96375 (different drugs) if they are given within 30 minutes of each other.

    Example:
    IV Push #1 given at 11:05 to 11:10
    IV Push #2 (different drug) given at 11:12 to 11:15

    Would this be coded as 96375 x 1 or 96375 x 2?

    Answer to the above question:

    Well if this was your only infusion/injection for this encounter it should be coded.
    96374x1
    and
    96375X1

    The 30 minute rule only applies to same drugs....if it the same drug within 30 minutes you could only do the one push. If it's different you could code both

  4. Default
    I agree with Diana11, thats exactly how its coded.

  5. #15
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    Quote Originally Posted by nancy.mash@utsouthwestern.edu View Post
    I know that you can bill 96376 (same drug) only if 30 minutes has elapsed. My question is can you bill 96375 (different drugs) if they are given within 30 minutes of each other.

    Example:
    IV Push #1 given at 11:05 to 11:10
    IV Push #2 (different drug) given at 11:12 to 11:15

    Would this be coded as 96375 x 1 or 96375 x 2?
    It would be coded as 96375 x2 if you already have your initial coded. As long as the drugs were not given at the exact same time, you can count it. Some drugs are admixed and there for you could only count on infusion code and if ran at the same time, but in different bags, you would code one as concurrent. HTH

  6. Default
    Quote Originally Posted by burksmail View Post
    The dx is pharyngitis and vomiting: IV hydration started at 10:50 a.m. and ran for one hour. However, at 11:45 a.m., a bag of Rocephin was added and ran for 30 minutes. IV was disconnected at 12:15 p.m. Is there a way to caputre the 55 minutes that the pt was being hydrated? Again, this is in a physician setting. Any help is appreciated.

    Thanks,
    Myra
    I would add 96365 for the rocephine IV that had run for 30 minutes. and a second code 96361 for the hydration that had run for 1 hour. I would not assign any modifiers since the mode of transmission is the same and there is no mention that a different IV site has been established..

  7. #17
    Location
    Springfield, MO
    Posts
    17
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    Quote Originally Posted by ajs View Post
    The reason I did not use the add on code 96361 is it is listed as an add on for 96360.

    I was thinking that if you had to use an add on code it would be 96366, but it is for greater than 30 min after the first hour. So I did not think you could code that based on the total time that was documented. I am not an expert in this area, I was just going by the notes in the CPT book for physician office Infusions.
    In response to the add on code. I work insurance denials and typically the 96361 will get denied as it must be billed with the primary code 96360. I don't think the 59 modifier will get it paid as it must be submitted with the primary code

    I would be interested to hear if you guys also work your denials and if this is being paid or denied when billed that way.

  8. Default
    I am new to coding and in the CPT code you are referring to 96360 the normal saline is included in this code, right? or do I code the normal saline?

  9. #19
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    Quote Originally Posted by horseluver View Post
    In response to the add on code. I work insurance denials and typically the 96361 will get denied as it must be billed with the primary code 96360. I don't think the 59 modifier will get it paid as it must be submitted with the primary code

    I would be interested to hear if you guys also work your denials and if this is being paid or denied when billed that way.
    We always put a 59 on the 96361, when it is appropiate and have had no problems getting paid.
    Last edited by nlaaron; 12-16-2011 at 01:22 PM.

  10. #20
    Default
    Quote Originally Posted by bienoo View Post
    I am new to coding and in the CPT code you are referring to 96360 the normal saline is included in this code, right? or do I code the normal saline?
    The saline is included in the hydration code, do not bill separately.
    Last edited by nlaaron; 12-16-2011 at 01:26 PM.

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