Coding, Classification & Reimbursement

1.  Infusion Therapy

Posted 04-18-2017 16:29

Patient is ordered an antibiotic IV push every 8 hours via PICC line, so is seen in infusion therapy 3 times in 24 hours. Patient comes to outpatient infusion therapy for each IV push, then returns home after each one. Would it be appropriate to code CPT 96374 (intravenous, push, single or initial substance/drug) three times, adding modifier XE to two of the codes? Or, would you code 96374 once, followed by 96376 twice?

Any help/advice would be greatly appreciated.

Thank you!



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Alyssa Eppers, RHIA
Inpatient/Outpatient Coder
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2.  RE: Infusion Therapy

Posted 04-19-2017 09:19
Beings the patient left each time and returned for a separate visit for each IV push, you'll report 96374 (1), &  96374 (1), and 96374 (1).   You'll only report 96376 if the patient remained in the outpt unit and received a second/third push within that one encounter.
This code has an MUE of 1, but an Audjudication Indicator of 3, so claim will probably get a denial for the MUE, but appeal and describe the order, separate encounters, and pushes to the MAC.  They should OK and reimburse for the 3 IV pushes per day.

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Sheila Goethel
Coding Services Senior Manager
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3.  RE: Infusion Therapy

Posted 04-19-2017 11:58
Dear Alyssa,

I would use code 96374 and then code 96376 for each additional encounter since you mentioned that the patient went home between each visit. As far as the modifier I am not sure if you would use it or not since I am not sure if this would be considered a distinct service or not. You would have to find out the proper method/processes of how the medication is administered and what the protocols are etc. for after the administration.

Jodi Miller, RHIT, CCS

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Jodi Miller, RHIT, CCS
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4.  RE: Infusion Therapy

Posted 04-20-2017 09:34
Attended an webinar on this yesterday and we were instructed to use Modifier 76 (repeat service) on the last 2.
96374, 96374-76, 96374-76.

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Nelda Laskey
RAC Coordinator/Coder
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5.  RE: Infusion Therapy

Posted 04-21-2017 09:37
When the additional IV pushes are administered during same encounter, they will be reported as "each additionals".  However, when the patient leaves and comes back, then the [second/third] service is a unique encounter and will be billed as an "initial".   See CPT Asst. Dec '09 and CPT Asst. Feb '09

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Sheila Goethel
Coding Services Senior Manager
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