How To Use CPT Code 96366

CPT 96366 refers to the administration of intravenous infusion for therapy, prophylaxis, or diagnosis for each additional hour after the first hour. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96366 procedures.

1. What is CPT 96366?

CPT 96366 is a medical billing code used to describe the administration of intravenous (IV) infusion for therapy, prophylaxis, or diagnosis for each additional hour after the first hour. This code is used by medical professionals to document and bill for the additional time spent administering IV infusion treatments to patients. It is essential for medical coders and billers to understand the specific circumstances and requirements for using this code to ensure accurate billing and reimbursement.

2. 96366 CPT code description

The official description of CPT code 96366 is: “Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)”.

3. Procedure

1. The provider discusses the need for additional infusion with the patient and/or family member, explaining why it is necessary and what to expect.
2. The provider compares the medication name and dosage on the label of the medication bag to the orders for the patient.
3. The provider administers additional prepackaged medications to an already established IV, sets the drip rate, and starts the infusion.
4. He may add the same substance or drug for as many hours as required for adequate infusion.

4. Qualifying circumstances

Patients eligible to receive CPT code 96366 services are those who require additional hours of intravenous infusion for therapy, prophylaxis, or diagnosis beyond the initial hour. This may include patients with chronic illnesses, infections, or other medical conditions that necessitate prolonged IV infusion treatments. The provider must determine the need for additional infusion hours based on the patient’s specific medical condition and treatment plan.

5. When to use CPT code 96366

It is appropriate to bill the 96366 CPT code when a patient requires additional hours of intravenous infusion for therapy, prophylaxis, or diagnosis beyond the initial hour. This code should be used in conjunction with the primary procedure code for the initial hour of infusion (CPT 96365) and any other applicable add-on codes for sequential or concurrent infusions (CPT 96367 and CPT 96368).

6. Documentation requirements

To support a claim for CPT 96366, the following information must be documented in the patient’s medical record:

• The specific substance or drug used for the infusion
• The total duration of the infusion, including the additional hours billed under CPT 96366
• The medical necessity for the additional infusion hours
• Any relevant patient history, symptoms, or diagnoses that justify the use of the infusion
• Details of the infusion procedure, including the IV site, drip rate, and any monitoring or interventions performed during the infusion

7. Billing guidelines

When billing for CPT code 96366, it is essential to follow specific guidelines and rules to ensure accurate reimbursement. This code should be used in conjunction with the primary procedure code for the initial hour of infusion (CPT 96365) and any other applicable add-on codes for sequential or concurrent infusions (CPT 96367 and CPT 96368). Additionally, the documentation for CPT 96366 must specify the name of the drug or other substance used for the infusion.

8. Historical information

CPT 96366 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 96366

Five similar codes to CPT 96366 and how they differentiate from CPT 96366 are:

1. CPT 96365: Describes the initial hour of intravenous infusion for therapy, prophylaxis, or diagnosis.
2. CPT 96367: Describes an additional sequential infusion of a new drug or substance, up to one hour.
3. CPT 96368: Describes a concurrent infusion of a different medication or substance.
4. CPT 96369: Describes the initial hour of subcutaneous infusion for therapy or prophylaxis.
5. CPT 96370: Describes each additional hour of subcutaneous infusion for therapy or prophylaxis.

10. Examples

Here are 10 detailed examples of CPT code 96366 procedures:

1. A patient with a severe infection requires a 3-hour IV antibiotic infusion. The first hour is billed under CPT 96365, and the additional two hours are billed under CPT 96366.
2. A patient undergoing chemotherapy receives a 4-hour infusion of a chemotherapeutic agent. The first hour is billed under CPT 96365, and the additional three hours are billed under CPT 96366.
3. A patient with Crohn’s disease requires a 2-hour IV infusion of a biologic medication. The first hour is billed under CPT 96365, and the additional hour is billed under CPT 96366.
4. A patient with severe dehydration receives a 5-hour IV hydration infusion. The first hour is billed under CPT 96365, and the additional four hours are billed under CPT 96366.
5. A patient with multiple sclerosis requires a 6-hour IV infusion of a disease-modifying therapy. The first hour is billed under CPT 96365, and the additional five hours are billed under CPT 96366.
6. A patient with rheumatoid arthritis receives a 3-hour IV infusion of a biologic medication. The first hour is billed under CPT 96365, and the additional two hours are billed under CPT 96366.
7. A patient with a severe migraine receives a 2-hour IV infusion of a migraine medication. The first hour is billed under CPT 96365, and the additional hour is billed under CPT 96366.
8. A patient with iron deficiency anemia requires a 4-hour IV infusion of iron. The first hour is billed under CPT 96365, and the additional three hours are billed under CPT 96366.
9. A patient with a severe asthma exacerbation receives a 3-hour IV infusion of a corticosteroid medication. The first hour is billed under CPT 96365, and the additional two hours are billed under CPT 96366.
10. A patient with a complex regional pain syndrome requires a 5-hour IV infusion of a pain medication. The first hour is billed under CPT 96365, and the additional four hours are billed under CPT 96366.