Pain Management Coding Alert

Question: Encounter notes indicate that one of our nonphysician practitioners (NPPs) performed a prophylactic infusion on a patient. Total infusion time was 107 minutes. Is this enough information to choose the proper procedure codes?

Connecticut Subscriber

Answer: No, there’s not enough info to make a definitive code choice. Go ask the provider whether the infusions were intravenous (IV) or subcutaneous (SubQ). Then, choose from the following coding strategies:

IV infusion: Report 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) for the first infusion hour and +96366 (… each additional hour [List separately in addition to code for primary procedure]) for the extra 37 minutes. Don’t forget to choose the appropriate J codes for the drug[s] the physician used.

SubQ infusion: Report 96369 (Subcutaneous infusion for therapy or prophylaxis [specify substance or drug]; initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site[s]) for the first infusion hour and +96370 (… each additional hour [List separately in addition to code for primary procedure]) for the extra 37 minutes. Don’t forget to choose the appropriate J codes for the drug[s] the physician used.