# Ketamine Infusion



## karras

One of our pain physicians would like to do a ketamine infusion on a patient with CRPS Type I in the clinic.  We are facility based.  I was looking at CPT code 96365.  Does anyone have any experience coding this type of infusion?  

Thanks.
Kim


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## Michele Hannon

Payers are all over the map with ketamine infusions. You might consider contacting the payer for guidance. Link to a recent review from Aetna:
http://www.aetna.com/cpb/medical/data/400_499/0447.html


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## dwaldman

https://www.aapc.com/memberarea/forums/showthread.php?t=51565

In the above past thread on ketamine injections, it is noted that in a facility setting 9636X codes can not be reported by the physician in POS 22 for example

In the below policy here are the codes they are listing.

https://www.bcidaho.com/providers/medical_policies/pd/mp_50116.asp


96365  Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour 

96366 Each additional hour, up to 8 hours (list separately in addition to code for primary procedure)  

 96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug  

HCPCS  J2001  Injection, lidocaine hydrochloride for intravenous infusion, 10 mg  

They additional placed this in the policy

Regulatory Status

Intravenous (IV) lidocaine is approved by the U.S. Food and Drug Administration (FDA) for systemic use in the acute treatment of arrhythmias and locally as an anesthetic. IV lidocaine for the treatment of chronic pain is an off-label use.

Ketamine hydrochloride injection is FDA-indicated for diagnostic and surgical procedures that do not require skeletal muscle relaxation, for the induction of anesthesia prior to the administration of other general anesthetic agents, and to supplement low-potency agents, such as nitrous oxide. IV ketamine for the treatment of chronic pain is an off-label use.


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## ALALA

*lidocaine bolus*

My question is this:  What code does a pain physician use to bill for his/her time/participation in a lidocaine bolus when it takes place in a facility, such as a surgical center?  I've gone over all the infusion/bolus codes in the current CPT however they don't advise for the physician coding.

Any help is appreciated.  Thank you!



dwaldman said:


> https://www.aapc.com/memberarea/forums/showthread.php?t=51565
> 
> In the above past thread on ketamine injections, it is noted that in a facility setting 9636X codes can not be reported by the physician in POS 22 for example
> 
> In the below policy here are the codes they are listing.
> 
> https://www.bcidaho.com/providers/medical_policies/pd/mp_50116.asp
> 
> 
> 96365  Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
> 
> 96366 Each additional hour, up to 8 hours (list separately in addition to code for primary procedure)
> 
> 96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
> 
> HCPCS  J2001  Injection, lidocaine hydrochloride for intravenous infusion, 10 mg
> 
> They additional placed this in the policy
> 
> Regulatory Status
> 
> Intravenous (IV) lidocaine is approved by the U.S. Food and Drug Administration (FDA) for systemic use in the acute treatment of arrhythmias and locally as an anesthetic. IV lidocaine for the treatment of chronic pain is an off-label use.
> 
> Ketamine hydrochloride injection is FDA-indicated for diagnostic and surgical procedures that do not require skeletal muscle relaxation, for the induction of anesthesia prior to the administration of other general anesthetic agents, and to supplement low-potency agents, such as nitrous oxide. IV ketamine for the treatment of chronic pain is an off-label use.


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## hgolfos

We've been reporting only the applicable documented E/M services when these are done in a facility.  CPT specifically states: "Codes 96360-96379 ... are not intended to be reported by the physician in the facility setting.  If a significant, separately identifiable office or other outpatient Evaluation and Management service is performed, the appropriate E/M service ... should be reported..."


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