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Thread: is this correct

  1. #1
    Join Date
    Apr 2007
    New Orleans

    Default is this correct

    AAPC: Back to School

    Still little confused on coding these infusion....All responses are appreciated..Thanks

  2. #2
    Join Date
    Apr 2007
    durham, nc


    I would bill :
    96413 x 1 unit
    96415 x 1 unit
    96367 x 4 units
    96361 x 1 unit (if not Medicare) or bill 96360-59 x 1 unit (Medicare insurance)

    The 96367 I billed at 4 units because 4 new drugs were infused at different times. The 96366 is only if a non-chemo drug is infused greater than 1 hour 31 minutes. Say J3487 was infused instead from 3:00-4:35. You would then bill 96367 for the first hour and 96366 for the second hour. With infusion codes, anything running 31 minutes or more past the first 60 minutes is considered a 2nd hour.

    Our Medicare payor wants us to bill the hydration code as initial with a 59 modifier but our commercial/Blue Shield want the subsequent hydration code billed when given with other drugs. I would check your payor guidelines regarding the hydration part of the visit.
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

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