Pulmonology Coding Alert

Question: We recently received a denial of infusion code +96366 even though it was a multiple infusion and it lasted well over an hour. Could you please review the rules for reporting infusion codes? Oregon Subscriber Answer: When coding multiple-substance infusion claims, report the initial infusion with 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour). If the initial infusion lasts more than an hour, include +96366 (... each additional hour [List separately in addition to code for primary procedure]) for each additional infusion hour. To rightfully report 96365-96366, the session must meet the following requirements: • The pulmonologist must be administering the infusion for therapeutic, prophylactic or diagnostic purposes. • The pulmonologist must supervise the entire session. • The infusion must last for longer than 30 minutes. • The infusion must not be an inherent component of another procedure, such as [...]