Pain Management Coding Alert

Question: One of our providers performed an intravenous (IV) infusion for prophylaxis. Encounter notes indicate that the service lasted 45 minutes and included a pair of drugs. How do I report the infusions?

Florida Subscriber

Answer: The initial infusion code is easy to spot from these notes, but the claim gets murkier when considering the add-on code to represent the second drug. You’re going to need some more information on which type of secondary infusion your provider performs before you can round out this claim.

Base code: No matter the type of secondary infusion, you’ll report 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) for the initial infusion. There are two types of secondary IV infusions; additional sequential and concurrent.

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)). Additional sequential IV infusions occur when the provider infuses a new drug/substance through the same IV access immediately after the initial drug/substance infusion. You’ll report these infusions with +96367.

Concurrent infusions occur when the provider “administers an intravenous infusion or infusions of multiple medications or substances concurrently with another infusion to prevent, treat, or diagnose a condition or disease” through the same IV line, according to Codify. So, when the provider performs two infusions simultaneously, you’ll report +96368 (... concurrent infusion (List separately in addition to code for primary procedure)) for each concurrent infusion.

J code alert: For many of the IV infusion services, you’ll be able to report a HCPCS J code for the drug supply. Go back and check the notes for the substances used during the service; then check the HCPCS manual, and your payer policies, to see if the drug/substance is separately codeable. 

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