A patient is admitted to observation and the physician orders an antibiotic IVPB administered over one hour and repeated every eight hours. The patient receives the first dose from 12 pm to 1 pm and the next dose from 8 pm to 9 pm. Would this be reported with codes 96365 and 96367?
Answer:
The facility may report code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify sub-
stance or drug); initial, up to 1 hour, for the first intravenous infusion of the antibiotic and code 96367, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure), to reflect the second antibiotic infusion.
The rationale for reporting both codes 96365 and 96367 relates to the use of only one initial service code
per IV site per encounter. The observation stay for that date would be considered a single encounter, for which 96365 and 96367 are reportable.
Answer:
The facility may report code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify sub-
stance or drug); initial, up to 1 hour, for the first intravenous infusion of the antibiotic and code 96367, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure), to reflect the second antibiotic infusion.
The rationale for reporting both codes 96365 and 96367 relates to the use of only one initial service code
per IV site per encounter. The observation stay for that date would be considered a single encounter, for which 96365 and 96367 are reportable.
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