How To Use CPT Code 96365

CPT 96365 describes the initial intravenous infusion of a medication or other substance for therapy, prophylaxis, or diagnosis for up to one hour. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96365?

CPT 96365 can be used to describe the initial intravenous infusion of a medication or other substance for therapy, prophylaxis, or diagnosis for up to one hour. This code is used when a healthcare provider administers the infusion to prevent, treat, or diagnose a condition or disease. The provider discusses the need for the infusion with the patient or a family member, sets up the equipment, inserts the needle or catheter into the patient’s vein, and administers the drug for a period up to one hour.

2. Official 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 healthcare provider discusses the need for the infusion with the patient 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, connecting it to the tubing.
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 starts the infusion, setting the drip rate and administering the drug for a period up to one hour.

4. Qualifying circumstances

Patients eligible to receive CPT 96365 services are those who require intravenous infusion for therapy, prophylaxis, or diagnosis. The infusion may be used to prevent, treat, or diagnose a condition or disease. The provider must administer the infusion for up to one hour.

5. When to use CPT code 96365

CPT code 96365 should be used when a healthcare provider administers the initial intravenous infusion of a medication or other substance for therapy, prophylaxis, or diagnosis for up to one hour. This code should be used for each initial infusion provided to the patient. If the infusion of the same drug lasts for more than one hour, use add-on code 96366. If the provider administers an additional infusion of a different medication or substance for up to one hour, use code 96367. If the provider administers a concurrent infusion of a different medication or substance for up to one hour, use code 96368.

6. Documentation requirements

To support a claim for CPT 96365, the healthcare provider must document the following information:

• The need for the infusion and the discussion with the patient or family member
• The specific medication or substance used for the infusion
• Date and duration of the infusion
• Start and end time of the infusion
• Comparison of the medication label to the orders
• Drip rate and administration of the drug

7. Billing guidelines

When billing for CPT 96365, ensure that the healthcare provider administers the initial intravenous infusion for up to one hour. Use add-on code 96366 if the infusion of the same drug lasts for more than one hour. Use code 96367 for an additional infusion of a different medication or substance for up to one hour. Use code 96368 for a concurrent infusion of a different medication or substance for up to one hour. It is important to specify the medication or substance used for the infusion in the documentation. Do not report CPT 96365 in the facility setting.

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. Examples

1. A nurse administering the initial intravenous infusion of antibiotics for therapy to a patient with a severe infection.
2. A physician administering the initial intravenous infusion of a contrast agent for diagnosis during a radiological procedure.
3. A pharmacist administering the initial intravenous infusion of a chemotherapy drug for therapy to a cancer patient.
4. A nurse administering the initial intravenous infusion of fluids and electrolytes for hydration to a dehydrated patient.
5. A respiratory therapist administering the initial intravenous infusion of a bronchodilator for therapy to a patient with asthma.
6. A nurse administering the initial intravenous infusion of a pain medication for therapy to a patient with severe pain.
7. A physician administering the initial intravenous infusion of a diagnostic dye for diagnosis during a cardiac procedure.
8. A pharmacist administering the initial intravenous infusion of an immunoglobulin for therapy to a patient with an immune deficiency.
9. A nurse administering the initial intravenous infusion of a blood product for therapy to a patient with severe anemia.
10. A physician administering the initial intravenous infusion of a medication to induce labor for therapy to a pregnant patient.