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IV Physician coding

  1. #1
    Default IV Physician coding
    Medical Coding Books
    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

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
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    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
    From what I am reading, you had a total infusion time of 1 hr and 25 minutes. According to the notes in the CPT book, since the Rocephin was infused, you would use the code for infusion of a theraputic substance as the primary code, so 96365 infusion up to 1 hour and specify the substance. Since the rest of the time was less than 30 min. you cannot bill an additional code. It must be a minimum of 30 min to add on time.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default Cpc
    I totally agree with Arlene.

  4. #4
    Default
    I disagree, you would just count only the 55 minutes of hydration before the drug started, bill the Rocephin with the 96365 as your initial and bill hydration 96361 with a -59 modifier. As long as no other drug was running at the same time as the saline then you can count it as long as it runs atleast 31 minutes.
    Last edited by nlaaron; 12-06-2011 at 01:49 PM.

  5. #5
    Location
    Tacoma, WA
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    1,087
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    Quote Originally Posted by erin30 View Post
    I disagree, you would just count only the 55 minutes of hydration before the drug started, bill the Rocephin with the 96365 as your initial and bill hydration 96361 with a -59 modifier. As long as no other drug was running at the same time as the saline then you can count it as long as it runs atleast 31 minutes.
    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.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  6. Default
    Quote Originally Posted by erin30 View Post
    I disagree, you would just count only the 55 minutes of hydration before the drug started, bill the Rocephin with the 96365 as your initial and bill hydration 96361 with a -59 modifier. As long as no other drug was running at the same time as the saline then you can count it as long as it runs atleast 31 minutes.
    I do infusion coding and this is exactly how I would code it.

  7. #7
    Default
    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.
    Its all good. This forum is here to give our suggestions to best the of our knowledge. I do infusion coding everyday. It still gets confusing at times.

  8. #8
    Location
    Everett, WA
    Posts
    886
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    It still amazes me how so few codes can cause such discrepancies in interpretations. No wonder why I feel at times that it will never be mastered........at least.....by me! About the time confidence begins to emerge a point will be brought up that will cause me to question everything that's been learned. Love the process, although still feel overwhelmed at times. This appears to be very normal in this profession, ha! It seems that MCR has some stringent rulings with these codes as compared with AMA directives? ---Suzanne E Byrum CPC

  9. #9
    Default
    Quote Originally Posted by ollielooya View Post
    It still amazes me how so few codes can cause such discrepancies in interpretations. No wonder why I feel at times that it will never be mastered........at least.....by me! About the time confidence begins to emerge a point will be brought up that will cause me to question everything that's been learned. Love the process, although still feel overwhelmed at times. This appears to be very normal in this profession, ha! It seems that MCR has some stringent rulings with these codes as compared with AMA directives? ---Suzanne E Byrum CPC
    Yep, I agree totally!

  10. Default Can you bill 96375 multiple times within 30 minutes?
    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?

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