tci ED Coding & Reimbursement Alert - 2022 Issue Q1

Reader Questions: Understand Infusion Coding Rules

Question: Progress notes indicate that my ED provider performed an intravenous (IV) infusion for therapy. The infusion lasted an hour and 46 minutes and involved a single substance. I reported 96365 x 2 on the facility claim, but the payer denied the claim. What went wrong? Michigan Subscriber Answer: You should have used a different code to represent the second block of infusion time. Your code choice for the first hour was correct. On resubmission, report 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) for the first hour and +96366...

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