Medication Administration Compliance

djglenn1@att.netdjglenn1@att.net
in COMPLIANCE

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!

Comments

  • trositrosi
    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. :)
  • dwilliamsrsidwilliamsrsi
    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.  
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