Basics about CPT code 96365, 96372, 96374 and 96360

Coding of diagnostic and therapeutic infusion, hydration are based on the stated hierarchy. As per the hierarchy, infusions should be coded primary to pushes, which is primary to injections. This hierarchy is to be followed in facility coding. However, for both physician and facility coding only one initial service code should be reported unless the documentation in the report support the two separate IV sites infusion or injection. For example, CPT code 96365 is used for coding the primary or initial code as per hierarchy and suppose if there are two or more IV site for infusion, then you can go ahead and used the same code with 59 or X-{EUPS}modifier (96365, 96359-XU).
IV Infusion (96365-96368)>IV pushes (96374-96376)> Injection (96372-96373) ( >Hydration (96360, +96361)

Coding tips for CPT code 96365, 96372, 96374 and 96360

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Description of CPT code 96365

96365 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
+96366 – each additional hour (List separately in addition to code for primary procedure)
+96367 – additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure)

The initial code should be selected based on the hierarchy. The hierarchy does not apply to physician coding. This hierarchy is only to be followed in facility coding.

For multiple injection or infusions, use the primary code for the initial service based on hierarchy for facility coding. And use add-on codes for the reporting the additional services by calculating the time.

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Subsequent infusion is a IV push of a new substance or drug following the initial or primary service.

Concurrent infusion is a new drug or substance infused at the same time as another substance or drug. This infusion is not time based and should be reported only once per day. Hydration is not allowed to reported concurrently with any other service.

Calculate time to find Correct CPT code

The start and stop time should be clearly documented to t code these services. Most of the time the start is documented but the stop time is not present in the medical report. For single infusion less than 15 minutes can be assumed as the IV push

Do not report 96365, 96374, 96372 and 96360 together unless there are two or more IV sites for infusion or injection. We can code only one primary code based on the hierarchy in facility coding.

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All add-on codes (+) should be used secondary codes along with other services. For example, IV push code +96375 can be coded as secondary code with initial IV infusion CPT code 96365.

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Intravenous infusions

IV infusions are reported with 96365-96368 and are divided based on the time and type of infusion. The initial infusion is reported with 96365 (upto 1 hour) once per encounter, unless the protocol requires two different venous accesss sites; each additional hour of the same drug/substance (upto 8 hours) is reported with 96366. In order to report code 96366, there must be infusion intervals of greater than 30 minutes (upto 1 hour), beyond the initial 1-hour increment of infusion.

Different drug/substance

Sometimes one infusion is provided and followed by another infusion of a different drug/substance (sequential infusions); in this case, the initial infusion is reported first with 96365, and the additional sequential infusion is reported with add-on code 96367 for each separate infusate mix.

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Sequential, initial concurrent infusions

When a sequential infusion runs for more than 1 hour, the cpt guidelines following ocde 96366 instruct the coder to report code 96366 for additional sequential hour(s). There are times more than one infusion of a different durg or substance is provided at the same time, in which case the initial or sequential infusion is listed first, and then the additional concurrent infusion is listed (96368). Code 96368 can be reported only once per encounter. If multiple drugs are mixed together in the same bag, only one administration code can be reported, but all drugs should be billed separately.

Substance infusions

Subcutaneous infusion for therapy is reported with codes 96369-96371. The initial subcutaneous infusion code 96369 reports up to 1 hour of infusion, and included the pump set-up and establishment of the site. Code 96370 is an add-on code that reports each additional hour, and 96371 is also an add-on code that reports an additional pump set-up with establishment of a new subcutaneous site.

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Therapeutic, prophylactic and diagnostic injections

Therapeutic, prophylactic and diagnostic injections are divided based on the administration method. Subcutaneous and intramuscular injections are reported with 96372, along with a code to report the substance injected. This code cannot be reported when injections are given without direct physician or other qualified professional supervision and does not include injections for allergen immunotherapy.

Intraarterial Injection

Intraarterial injections are reported with code 96373. IV push is reported with 96374 for a single or intial drug or substance. Intraarterial or IV push is defined as an infusion lasting 15 minutes or less, or an injection in which the individual who administers the drug or substance is continually present to administer the injection and observe the patient. Additional sequential IV push is reported with add-on codes 96375 for a new drug or substance or 96376 for the same drug or substance when provide in a facility. Once again, all drugs are to be separately using HCPCS national level II codes or CPT code 99070.