Wiki Billing for two infusions in one day in HOPD

[AppliedPolicy]

I am trying to figure out how to code/bill in an outpatient setting for a drug that is infused twice per day (every 12 hours). The initial CPT code is 96365 and has a status indicator of “S” is under APC 0439. Do I bill 96366 for the second infusion? And if so, can I bill the APC 0437?

 

[mitchellde]

if it is the same infusion billed in 2 separate sessions, the use the 96365 twice with a 76 modifier on the second one.

 

[AppliedPolicy]

Deborah, thank you for your response. What is meant by "same infusion"? For the drug to work, it has to be infused twice per day, every 12 hours. So are you saying it is the same infusion because the first would not work without the second?

Can I bill the APC twice as long as I use the 76 modifier when I bill it the second time?

Thanks so much for your help!

 

[mitchellde]

From what you are saying it is the same drug which has to be infused in 2 different sessions 12 hours apart. Therefore the second infusion is not a subsequent infusion to an initial in the same session, it is a new initial infusion of the same drug in a separate session but on the same day. I know this works in the Hospital outpatient setting, with the 76. for the the same APC. I assume it is the same for the ASC.