Medication Administration Compliance

djglenn1@att.net

My team of Nurse Auditors recently came across an unusual scenario and we are unsure in our choice of medication administration cpt codes/charges.  This is the scenario - in an unstable hypoglycemic patient, the physician ordered IV Dextrose 10% (D10) to be given in a 16-minute infusion.  The patient received D10 in 4 separate infusions, each lasting 16 minutes.  The first 16-minute infusion is charged as the "initial" IV infusion, 96365 X1. Are we able to charge the subsequent 16-minute infusions as 96366 X3, even though the infusions lasted only 16 minutes each and not > 30 minutes?  According to CPT guidelines, report add-on code 96366 in conjunction with 96365 (initial), report 96366 for infusion intervals > 30 minutes, beyond the first 1 hour increment, and report 96366 to identify each second and subsequent infusion of the same drug/substance. We want to ensure appropriate reimbursement. Thank you!

trosi

if all 4 infusions were the same medication and given during the same encounter, we would add up the times [4 x 16 = 64] and we would only charge the 96365 initial hour of administration.  Likely the same line/same encounter so you add up the times and charge per CPT rules. Since it was 90 minutes of less, you only get to code/charge the initial hour.  If this is incorrect, someone will need to let me know.  It is how we have done it for years.

dwilliamsrsi

CPT Assistant for December 2011 (Volume 21, Issue 12, page 3) provides a coding tip that explains how to charge services when multiple timed infusion are reported.