Neurology & Pain Management Coding Alert

Question: Notes indicate that my provider performed an intravenous (IV) infusion for therapy. The infusion lasted an hour and 46 minutes and involved a single substance. I reported 96365 x 2 and received a denial. What went wrong here?

Ohio Subscriber

Answer: You should have used a different code to represent the second block of infusion time. Your code choice for the first hour was correct.

On resubmission, report 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) for the first hour and +96366 (… each additional hour (List separately in addition to code for primary procedure)) for the remaining 46 minutes of infusion time.

Remember: Per CPT^®, +96366 is for use for additional time beyond the first hour of infusion for the same substance. If the provider introduces a new drug after the initial infusion, report +96367 (… additional sequential infusion of a new drug/ substance, up to 1 hour (List separately in addition to code for primary procedure)) instead. If the provider performed a different infusion at the same time as the first infusion, report +96368 (… concurrent infusion (List separately in addition to code for primary procedure)).