Inpatient Facility Coding & Compliance Alert

Question: A 66-year-old patient was admitted through the ER and received a two-hour therapeutic infusion of a drug. One hour later, he received an IV push of the same drug. How do we code the infusions?

Nevada Subscriber

Answer: Because this encounter occurred in a facility setting, you should use the coding hierarchy as provided in CPT®. You’ll submit three codes for this encounter, at least for the infusions. Start with 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) for the first hour of infusion and +96366 (… each additional hour [List separately in addition to code for primary procedure]) for the second hour of infusion. The IV push occurs an hour after the infusion. The IV push codes include 96374 for single or initial push, 96375 as an add-on code for each additional sequential push of new drug or substance, and then another add-on code, 96376 (… each additional sequential intravenous push of the same substance/drug provided in a facility [Report 96367 in conjunction with 96365, 96374, 96409, 96413]) identifies the IV push provided as a secondary or subsequent service after a different, higher level, initial service is administered through the same IV access. ."

Note: Although the infusion/injection coding structures have stabilized, CPT® coding guidelines continue to be modified. Always verify the latest instructions before filing claims.