Cardiology Question for the Week of February 1, 2016

Question:

If a patient has a SOLU-MEDROL® intravenous (IV) push prior to a heart catheterization because of an iodine allergy, would code 96374 apply?

Answer

There are National Correct Coding Initiative (CCI) edits for 96374 and the heart cath codes.  The edit can be over-ridden if medically appropriate. 

However, according to the NCCI Policy Manual, chapter 11, “Under the OPPS, drug administration services related to operative procedures are included in the associated procedural HCPCS/CPT codes. Examples of such drug administration services include, but are not limited to, anesthesia (local or other), hydration, and medications such as anxiolytics or antibiotics. Providers should not report CPT codes 96360–96376 for these services.” 

In addition, the American Hospital Association’s Coding Clinic for HCPCS (4Q, 2007) included a Q & A concerning prophylactic antibiotic IV infusion given prior to surgery for a patient with mitral valve prolapse.  The response indicated that although the infusion was specific to the patient and not part of the regular routine, the administration of the medication was due to the surgery, and, therefore, the administration was prophylactic and would not be reported separately.  

The same applies in your situation. The patient was given the IV SOLU-MEDROL® because of the surgery, so 96374 would not be appropriate.

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