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burksmail

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The dx is pharyngitis and vomiting: IV hydration started at 10:50 a.m. and ran for one hour. However, at 11:45 a.m., a bag of Rocephin was added and ran for 30 minutes. IV was disconnected at 12:15 p.m. Is there a way to caputre the 55 minutes that the pt was being hydrated? Again, this is in a physician setting. Any help is appreciated.

Thanks,
Myra
 
burksmail said:
The dx is pharyngitis and vomiting: IV hydration started at 10:50 a.m. and ran for one hour. However, at 11:45 a.m., a bag of Rocephin was added and ran for 30 minutes. IV was disconnected at 12:15 p.m. Is there a way to caputre the 55 minutes that the pt was being hydrated? Again, this is in a physician setting. Any help is appreciated.

Thanks,
Myra
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From what I am reading, you had a total infusion time of 1 hr and 25 minutes. According to the notes in the CPT book, since the Rocephin was infused, you would use the code for infusion of a theraputic substance as the primary code, so 96365 infusion up to 1 hour and specify the substance. Since the rest of the time was less than 30 min. you cannot bill an additional code. It must be a minimum of 30 min to add on time.
 
I disagree, you would just count only the 55 minutes of hydration before the drug started, bill the Rocephin with the 96365 as your initial and bill hydration 96361 with a -59 modifier. As long as no other drug was running at the same time as the saline then you can count it as long as it runs atleast 31 minutes.
 
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erin30 said:
I disagree, you would just count only the 55 minutes of hydration before the drug started, bill the Rocephin with the 96365 as your initial and bill hydration 96361 with a -59 modifier. As long as no other drug was running at the same time as the saline then you can count it as long as it runs atleast 31 minutes.
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The reason I did not use the add on code 96361 is it is listed as an add on for 96360.

I was thinking that if you had to use an add on code it would be 96366, but it is for greater than 30 min after the first hour. So I did not think you could code that based on the total time that was documented. I am not an expert in this area, I was just going by the notes in the CPT book for physician office Infusions.
 
erin30 said:
I disagree, you would just count only the 55 minutes of hydration before the drug started, bill the Rocephin with the 96365 as your initial and bill hydration 96361 with a -59 modifier. As long as no other drug was running at the same time as the saline then you can count it as long as it runs atleast 31 minutes.
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I do infusion coding and this is exactly how I would code it.
 
ajs said:
The reason I did not use the add on code 96361 is it is listed as an add on for 96360.

I was thinking that if you had to use an add on code it would be 96366, but it is for greater than 30 min after the first hour. So I did not think you could code that based on the total time that was documented. I am not an expert in this area, I was just going by the notes in the CPT book for physician office Infusions.
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Its all good. This forum is here to give our suggestions to best the of our knowledge. I do infusion coding everyday. It still gets confusing at times.
 
It still amazes me how so few codes can cause such discrepancies in interpretations. No wonder why I feel at times that it will never be mastered........at least.....by me! About the time confidence begins to emerge a point will be brought up that will cause me to question everything that's been learned. Love the process, although still feel overwhelmed at times. This appears to be very normal in this profession, ha! It seems that MCR has some stringent rulings with these codes as compared with AMA directives? ---Suzanne E Byrum CPC
 
ollielooya said:
It still amazes me how so few codes can cause such discrepancies in interpretations. No wonder why I feel at times that it will never be mastered........at least.....by me! About the time confidence begins to emerge a point will be brought up that will cause me to question everything that's been learned. Love the process, although still feel overwhelmed at times. This appears to be very normal in this profession, ha! It seems that MCR has some stringent rulings with these codes as compared with AMA directives? ---Suzanne E Byrum CPC
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Yep, I agree totally! :eek:
 
Can you bill 96375 multiple times within 30 minutes?

I know that you can bill 96376 (same drug) only if 30 minutes has elapsed. My question is can you bill 96375 (different drugs) if they are given within 30 minutes of each other.

Example:
IV Push #1 given at 11:05 to 11:10
IV Push #2 (different drug) given at 11:12 to 11:15

Would this be coded as 96375 x 1 or 96375 x 2?
 
Per CPT GUIDELINES you would bill 96365 fro the rocephin time given next you would bill J0696 (HCPC) code for the drug given bill the number of milligrams for rocephin. Next you would per CPT GUIDELINES "report 96361 to identify hydration if provided as a second or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access!
Ex:
96365 initial up to one hour
J0696 Rocephin 250 mg
96361 Each additional hour

I hope this helps! I've billed these type of treatments along with chemo treatments for over seven years
 
dmtaylor98 said:
Per CPT GUIDELINES you would bill 96365 fro the rocephin time given next you would bill J0696 (HCPC) code for the drug given bill the number of milligrams for rocephin. Next you would per CPT GUIDELINES "report 96361 to identify hydration if provided as a second or subsequent service after a different initial service (96360, 96365, 96374, 96409, 96413) is administered through the same IV access!
Ex:
96365 initial up to one hour
J0696 Rocephin 250 mg
96361 Each additional hour

I hope this helps! I've billed these type of treatments along with chemo treatments for over seven years
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Thank you, it does help to get clarification from someone who actually uses the codes! I am learning so much from the forums these days!
 
I know that you can bill 96376 (same drug) only if 30 minutes has elapsed. My question is can you bill 96375 (different drugs) if they are given within 30 minutes of each other.

Example:
IV Push #1 given at 11:05 to 11:10
IV Push #2 (different drug) given at 11:12 to 11:15

Would this be coded as 96375 x 1 or 96375 x 2?

Answer to the above question:

Well if this was your only infusion/injection for this encounter it should be coded.
96374x1
and
96375X1

The 30 minute rule only applies to same drugs....if it the same drug within 30 minutes you could only do the one push. If it's different you could code both
 
nancy.mash@utsouthwestern.edu said:
I know that you can bill 96376 (same drug) only if 30 minutes has elapsed. My question is can you bill 96375 (different drugs) if they are given within 30 minutes of each other.

Example:
IV Push #1 given at 11:05 to 11:10
IV Push #2 (different drug) given at 11:12 to 11:15

Would this be coded as 96375 x 1 or 96375 x 2?
Click to expand...

It would be coded as 96375 x2 if you already have your initial coded. As long as the drugs were not given at the exact same time, you can count it. Some drugs are admixed and there for you could only count on infusion code and if ran at the same time, but in different bags, you would code one as concurrent. HTH:eek:
 
burksmail said:
The dx is pharyngitis and vomiting: IV hydration started at 10:50 a.m. and ran for one hour. However, at 11:45 a.m., a bag of Rocephin was added and ran for 30 minutes. IV was disconnected at 12:15 p.m. Is there a way to caputre the 55 minutes that the pt was being hydrated? Again, this is in a physician setting. Any help is appreciated.

Thanks,
Myra
Click to expand...

I would add 96365 for the rocephine IV that had run for 30 minutes. and a second code 96361 for the hydration that had run for 1 hour. I would not assign any modifiers since the mode of transmission is the same and there is no mention that a different IV site has been established..
 
ajs said:
The reason I did not use the add on code 96361 is it is listed as an add on for 96360.

I was thinking that if you had to use an add on code it would be 96366, but it is for greater than 30 min after the first hour. So I did not think you could code that based on the total time that was documented. I am not an expert in this area, I was just going by the notes in the CPT book for physician office Infusions.
Click to expand...

In response to the add on code. I work insurance denials and typically the 96361 will get denied as it must be billed with the primary code 96360. I don't think the 59 modifier will get it paid as it must be submitted with the primary code

I would be interested to hear if you guys also work your denials and if this is being paid or denied when billed that way.
 
I am new to coding and in the CPT code you are referring to 96360 the normal saline is included in this code, right? or do I code the normal saline?:confused:
 
horseluver said:
In response to the add on code. I work insurance denials and typically the 96361 will get denied as it must be billed with the primary code 96360. I don't think the 59 modifier will get it paid as it must be submitted with the primary code

I would be interested to hear if you guys also work your denials and if this is being paid or denied when billed that way.
Click to expand...

We always put a 59 on the 96361, when it is appropiate and have had no problems getting paid.
 
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bienoo said:
I am new to coding and in the CPT code you are referring to 96360 the normal saline is included in this code, right? or do I code the normal saline?:confused:
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The saline is included in the hydration code, do not bill separately.
 
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IV Push

In your example, you are only pushing 2 times. It would be 96374 for #1 and 96375 for drug #2. If there were a third drug pushed it would be 96374, 96375 x 2.

R.Sortino
RHIT,CCS,CPC
 
Nancy,

This would be coded as 96374 x1, 96375 x1, or 96375 x2 if you have another initial code not listed (96365, 96413). There are no time restrictions for CPT 96375 so it can be charged multiple times. Hope that helps you.
 
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