CPT 96365 can be used to report the initial intravenous infusion of a medication or other substance for up to one hour for therapy, prevention, or diagnosis.
What Is CPT Code 96365?
CPT code 96365 can be used when a provider administers an initial intravenous infusion of medication or other substance for up to one hour to treat, prevent, or diagnose a medical condition.
The provider will first consult with the patient or a family member about the infusion and the potential risks and benefits.
Then, the provider sets up the equipment, inserts the needle or catheter into the patient’s vein, connects it to tubing, verifies the medication name and dosage match the patient’s orders, and starts the infusion.
The CPT book describes CPT code 96365 as: “Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.”
The provider administers an initial intravenous infusion of a medication or other substance for up to one hour to address a medical condition or disease.
The provider consults with the patient and/or a family member to explain the need for the infusion, potential risks, and benefits.
The provider then sets up the equipment and inserts the needle or catheter into the patient’s vein, connecting it to the tubing.
Then, they verify the medication name and dosage on the label of the medication bag match the patient’s orders and start the infusion.
Finally, they adjust the drip rate and monitor the patient throughout the infusion.
How To Use CPT 96365
Use CPT 96365 for each initial intravenous (IV) drug infusion. Documenting the name of the drug or other substance used in the procedure is essential.
If the provider performs an IV infusion of the same drug for more than one hour, use add-on codes CPT 96366 and CPT 96365.
When the provider administers an additional IV infusion or infusions of a different medication or substance for up to one hour, use CPT 96367 in addition to CPT 96365.
When the provider administers a concurrent IV infusion of a different medication or substance for up to one hour, use CPT 96368 in addition to CPT 96365.
CPT 96365 can also identify therapeutic, prophylactic, or diagnostic drug infusion or injection if administered as a secondary or subsequent service through the same IV access associated with CPT 96413.
It would be best if you documented the name of the drug or other substance used for the infusion when you use CPT 96413.
If multiple administrations are individually prepared, these services should be recognized and reported as individual administrations.
The time frame of each separate administration service for the same or different drugs should be considered rather than basing the code on the total time of all administrations.
Chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services, which are prior to hydration services. Infusions are primary to pushes, which are primary to injections.
The provider should report the service in the office setting and determines the primary reason for the hydration or other administration service and thus would be able to select the primary hydration or drug administration service code.