Oncology & Hematology Coding Alert

Question: If I code for the physician, am I supposed to report +96376 for services that are in the facility instead of in an office?

Missouri Subscriber

Answer: No. Only the facility should report +96376 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of the same substance/drug provided in a facility [List separately in addition to code for primary procedure]).

CPT includes a crucial parenthetical note under +96376 to keep physician coding on the straight and narrow: "(96376 may be reported by facilities only)."

Tip: Code +96376 is status "X" in the physician fee schedule. This means: "Statutory Exclusion. These codes represent an item or service that is not in the statutory definition of 'physician services' for fee schedule payment purposes. No RVUs or payment amounts are shown for these codes, and no payment may be made under the physician fee schedule," according to the "National Physician Fee Schedule Relative Value File Calendar Year 2009."

The "facility" the code refers to is the hospital outpatient department. CPT added +96376 after getting comments about pushing the same drug multiple times in the emergency department. Hospitals wanted a way to capture the nursing resources required. When hospitals report the code, CMS can analyze how many patient encounters require the service and adjust ambulatory payment classification (APC) allowances accordingly.