Neurology & Pain Management Coding Alert

Question: We have quite a few 90766 denials stating that the "qualifying service was not identified." We submit 96413 as the initial charge code. Should we be doing something differently?

Maine Subscriber

Answer: The most likely culprit is your code combination. You can't report +90766 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour) without an "initial hour" code.

CPT guidelines state that 90766 must be reported with either 90765 (... initial, up to 1 hour) or +90767 (... additional sequential infusion, up to 1 hour). This has always been the case, but the parenthetical notes in the 2008 CPT manual make this clearer.

Don't forget: Use 90767 as the additional sequential code when you report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) as the initial code. CPT guidelines instruct you to use the chemotherapy administration codes for anti-neoplastic agents, certain monoclonal antibody agents and other biological response modifiers.

Use 90766 when there are additional hours of non-chemotherapy infusion, and report it only with 90765 or 90767.