Pharmacy Question for the Week of March 15, 2021

Pharmacy Compliance Question of the Week

Question:

Can you tell us if codes 96365 and 96368 are appropriate for the following scenario? The patient is seen in the outpatient clinic for drug infusion. Drug A is administered from 6:00 am to 7:30 am. Drug B is administered through the same intravenous line from 7:00 am to 4:00 pm.

Answer:

This scenario would qualify for use of codes 96365 and 96367. To determine the billable units, you have to take into consideration the time of overlap. The sequential IV ran from 7:00 am to 4:00 pm for a total of nine hours. This would be coded as 96365 x1 and 96366 x8 units. The first IV ran an hour and 30 minutes (90 minutes). The amount of overlap (concurrent time) is 30 minutes so this will be deducted from the total run time of 90 minutes. This IV may be coded as 96367 x1 unit. How would the coding differ from the previous scenario if Drug A and Drug B start and stop times are within a minute or two of each other? We find in many of our reviews that the time of overlap for two different drugs can vary. Some drugs appear to be given within a few minutes of each other. For example, the first drug start time may say 9:30 am and the second drug start time may say 9:32 am. The end times are also within a couple of minutes of each other. So how would this be coded? One administration would be coded as 96365 and the other coded as concurrent 96368, based on administration times documented. However, if this
scenario occurs frequently, check with nursing to verify the actual start and stop times.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.