Anesthesia Coding Alert

Question: Our pain management specialist saw a patient with complex regional pain syndrome (CRPS) I. The specialist administered a therapeutic intravenous (IV) push for therapy in the patient’s arm. He followed with another push of the same substance. Can I report more than one CPT^® code for these pushes? Or do I only count one since they were administered during the same encounter?

Nevada Subscriber

Answer: The correct answer depends on how much time elapsed between the pushes. If the second push occurred less than 30 minutes after the end of the first push, report 96374 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug) for the complete encounter (one code for both pushes).

If the second push occurred more than 30 minutes after the first, you can report 96374 for the first push and add +96376 (… each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)) for the second.

You’ll need to remember to document the push times before submitting the claim. If the pain management specialist hasn’t already provided enough details to prove that the pushes occurred more than 30 minutes apart, get that detail added to the record before filing with 96374 and +96376 (if submitting both codes is accurate). Payers are pretty insistent that you use the add-on code properly, so any lapse in documentation could affect the claim’s payment.

Document diagnosis: For this patient, you’ll choose from the following ICD-10 codes, depending on the patient’s specific condition:

• G90.511 — Complex regional pain syndrome I of right upper limb
• G90.512 — … left upper limb 
• G90.513 — … upper limb, bilateral
• G90.519 — … unspecified upper limb.

Also: Don’t forget to code for the drug supply as well as the IV push — or pushes.