Pain Management Coding Alert

Question: What is the difference between an additional sequential intravenous (IV) infusion and a concurrent IV infusion, for prophylactic purposes?

Massachusetts Subscriber

Answer: There are a couple of differences between additional sequential and concurrent IV infusions. First, however, here's what they have in common: CPT^® lists both types of infusions as add-on codes for the 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) base code, among others. For a prophylactic IV infusion, you'll use 96365 for the first hour.

Additional sequential infusion: During this type of infusion, the provider infuses a "new drug/substance provided as a secondary or subsequent service after a different initial service is administered through the same IV access," according to CPT^® 2018. You'll report each additional sequential infusion with +96367 (... additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)) along with 96365.

Concurrent infusion: During this type of infusion, the provider administers another drug/substance at the same time as the primary IV drug/substance. For concurrent IV infusions, you'll report +96368 (... concurrent infusion (List separately in addition to code for primary procedure)) for each concurrent drug/substance along with 96365.

Not just for IV infusions: Although +96367 and +96368 are linked to 96365 for IV infusions, you can also use these add-on codes with other CPT^® codes:

+96367: You can use this as an add-on for any of the following codes, provided the encounter merits its use:

• 96374 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
• 96409 - Chemotherapy administration; intravenous, push technique, single or initial substance/drug
• 96413 - Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug.

+96368: You can use this add-on code along with any of the following codes, provided the encounter merits its use:

• +96366 - ... each additional hour (List separately in addition to code for primary procedure)  
• 96413
• +96415 - ... each additional hour (List separately in addition to code for primary procedure)
• 96416 - Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump. 

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