Wiki Dapto coding

[Lewis16]

I literally passed my test less than a week ago, YAY! Not in a coding job yet, but do authorizations for Infusion Clinic in the hospital and I had a patient come in with a HUGE bill for 16 days of Dapto. She came in daily for 16 days and had a PICC line, and had Dapto injection. 96365 was billed each day...is that correct or should it be an initial then subsequent? UHC Medicare is charging this poor patient $3200!! Let me know what y'all would have coded just for my own curiosity. Its in the hands of Revenue Integrity at the moment but figured its a great learning opportunity!!

 

[rachaelwilleford]

How is it documented? When I was in clinic, we had patients who came in each day for an infusion of daptomycin. It wasn't one long infusion which required a prolonged infusion pump, but rather one infusion session per day. In that case, yes 96365 each day would be correct. UHC Medicare is likely leaving 20% of the allowed amount to the patient for the administration(s) and drugs, resulting in $3200 total for the month (I'm hoping).

Subsequent infusion codes would be billed if there were additional time, injections, pushes, on the same encounter. It's based on the hierarchy of the infusion - what is the primary administration and other administration codes are subsequent.

 

[Lewis16]

@rachaelwilleford Its 1 per day...Patients who have straight MCR can do it for probably $1000 max which blows my mind! I see you are in Carencro? I went to Lafayette High! Go Lions Thanks for your input!