Wiki IV Guidelines for Charging CPT 96366 following CPT 96367 - How should I charge?

[Pvdcoder]

Hello,
My question is, if a patient in the ED received multiple IV drug infusions and one of the drugs only ran for 63 minutes, would I charge 96367 alone or do I add 96366 because it ran over 60 minutes? Here are the drugs that were given:

Patient was in the ER from 03/01/18 to 03/02/18


Infusions:

Vancomycin 3/1 2059-2336 total of 157 minutes
Azactam 3/1 2207-0024 total of 137 minutes
Mag Sulfate 3/1 2337-0129 total of 112 minutes
Flagyl 3/2 0026-0129 total of 63 minutes

I would charge it this way: Vanco - 96365 & 96366 x 2, Azactam – 96367 & 96366 x 1, Mag Sulfate – 96367 & 96366 x 1 and Flagyl – 96367.

I am being told that I should add CPT 96366 to the Flagyl charge because it ran over 63 minutes but I thought in order to charge 96366 it had to run at least 91 minutes. Does it only have to run over 60 minutes when charging a sequential infusion (96367) to add the subsequent (96366) charge? Can someone please explain if I should have charged the 96366 and why?

 

[cleanclaims]

I used this article from AHIMA and it helped with a couple of the scenarios that I had. See if this helps: http://bok.ahima.org/doc?oid=107707#.Wq79tOSG_IU

Kat

 

[khines80]

Infusion Charging

Since you did not specify, I'm going to assume that this patient had only one vascular access site. I think you've got a very good idea of what should be charged. I just have one change and will try to answer your questions as well.

With that, you would charge this:

Vanco 3/1 96365 x1 and 96366 x2
Azactam 3/1 96368 x1 because it ran concurrently with vanco and no separate IV line was indicated
Mag Sulfate 3/1 96367 x1 and 96366 x1
Flagyl 3/2 96367 x1. You can only report 96366 for infusion intervals of greater than 30 minutes beyond the 1 hour increments. So yes, the drug would need to run at least 31 minutes to charge 96366 for the same drug; no CPT 96366 supported in this case.

CPT 96367 is an additional sequential infusion of a new drug/substance, up to 1 hour. This would be used when a new drug/substance is being administered in the same vascular access line. As with the initial infusion, the drug/substance needs to run at least 16 minutes to charge.

 

[Mageshsubramaniyan]

Can anyone tell me for CPT 96367 is an additional sequential infusion of a new drug/substance minimum time with some referral notes.

For example:
Physician given two different drugs, drug A and Drug B. Drug A given at 12.00 PM to 2.00 PM and drug B is given at 2.05 PM to 2.25 PM.
Is that i have to code 96365, 96367, 96366 or 96365, 96366 and 96375?

 

[shereen]

I would go with 96365, 96366 and 96367.