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.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join