How To Use CPT Code 96365

CPT 96365 refers to the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 96365.

1. What is CPT 96365?

CPT 96365 is a medical billing code used to describe the initial intravenous infusion of a medication or other substance for a period up to one hour. This code is used to bill for the administration of a substance to prevent, treat, or diagnose a condition or disease. The infusion may be therapeutic, prophylactic, or diagnostic in nature.

2. 96365 CPT code description

The official description of CPT code 96365 is: “Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.”

3. Procedure

1. The provider discusses the need for the infusion with the patient and/or a family member, explaining why it is necessary and what to expect.
2. The provider sets up the equipment and inserts the needle or catheter into the patient’s vein and connects it to the tubing. The provider may use an existing indwelling intravascular access catheter or port.
3. The provider compares the medication name and dosage on the label of the medication bag to the orders for the patient.
4. The provider then starts the infusion, sets the drip rate, and administers the drug for a period up to one hour.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 96365 services are those who require the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. The infusion may be therapeutic, prophylactic, or diagnostic in nature. The provider must determine the necessity of the infusion based on the patient’s medical condition and the specific substance being administered.

5. When to use CPT code 96365

It is appropriate to bill the 96365 CPT code when the provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. The infusion must be the first of its kind for the patient during the encounter, and the provider must document the name of the drug or other substance used for the infusion.

6. Documentation requirements

To support a claim for CPT 96365, the following information must be documented:

• The patient’s medical condition and the specific substance being administered.
• The necessity of the infusion based on the patient’s medical condition.
• The name of the drug or other substance used for the infusion.
• The start and end times of the infusion.
• The dosage and drip rate of the medication or substance.
• Any additional infusions or injections administered during the encounter.

7. Billing guidelines

When billing for CPT code 96365, follow these guidelines:

• Use 96365 for each initial IV infusion of a drug.
• Document the name of the drug or other substance used for the infusion.
• If the provider performs IV infusion of the same drug for more than one hour, use add-on code 96366.
• When administering additional intravenous infusions of a different medication or substance, use 96367 or 96368 as appropriate.
• When reporting IV infusion codes, select the initial code using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services, which are primary to hydration services.

8. Historical information

CPT 96365 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition.

9. Similar codes to CPT 96365

Five similar codes to CPT 96365 and how they differentiate are:

• CPT 96366: Used for each additional hour of IV infusion of the same drug.
• CPT 96367: Used for additional sequential infusion of a new drug or substance, up to one hour.
• CPT 96368: Used for concurrent infusion of a different medication or substance, up to one hour.
• CPT 96369: Used for subcutaneous infusion for therapy or prophylaxis, initial, up to one hour.
• CPT 96370: Used for each additional hour of subcutaneous infusion for therapy or prophylaxis.

10. Examples

Here are 10 detailed examples of CPT code 96365 procedures:

1. Initial IV infusion of antibiotics for a patient with a severe infection.
2. Initial IV infusion of a pain medication for a patient with chronic pain.
3. Initial IV infusion of a blood product for a patient with anemia.
4. Initial IV infusion of a chemotherapy drug for a cancer patient.
5. Initial IV infusion of a medication to treat a patient with an autoimmune disorder.
6. Initial IV infusion of a medication to prevent blood clots in a patient at risk for deep vein thrombosis.
7. Initial IV infusion of a medication to treat a patient with a severe allergic reaction.
8. Initial IV infusion of a medication to manage a patient’s high blood pressure.
9. Initial IV infusion of a medication to treat a patient with a severe electrolyte imbalance.
10. Initial IV infusion of a medication to manage a patient’s symptoms during a severe asthma attack.