How To Use CPT Code 96367

CPT 96367 describes the administration of an additional intravenous infusion or infusions, after an initial infusion, of a different medication or substance 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 96367?

CPT 96367 can be used to describe the administration of an additional intravenous infusion or infusions, after an initial infusion, of a different medication or substance for up to one hour. This code is used when a provider administers a secondary or subsequent infusion of a new drug or substance through the same IV access.

2. Official Description

The official description of CPT code 96367 is: ‘Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure).’ This code should be reported in conjunction with other codes to identify the infusion of a new drug or substance provided as a secondary or subsequent service after a different initial service is administered through the same IV access.

3. Procedure

1. The provider discusses the need for an additional infusion with the patient 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 an additional prepackaged medication of a different drug from the initial infusion through an already established IV.
4. The provider sets the drip rate and starts the infusion, which continues for up to one hour.

4. Qualifying circumstances

CPT 96367 is used when an additional infusion of a different medication or substance is administered after an initial infusion. This code is appropriate for preventive, therapeutic, or diagnostic infusions. It should be noted that this code is not used for chemotherapy or other highly complex drug or biologic agent administration.

5. When to use CPT code 96367

CPT code 96367 should be used when an additional infusion of a different medication or substance is administered after an initial infusion. It is important to report this code only once per sequential infusion of the same drug or substance. The documentation must specify the drug or substance used for the infusion.

6. Documentation requirements

To support a claim for CPT 96367, the provider must document the following information:

• The need for an additional infusion and the reason for it
• The medication name and dosage on the label of the medication bag
• The date and duration of the infusion
• The drug or substance used for the infusion

7. Billing guidelines

When billing for CPT 96367, ensure that the documentation supports the need for an additional infusion of a different medication or substance after an initial infusion. This code should be reported in conjunction with other appropriate primary codes. It is important to note that payers may not reimburse for CPT 96367 if it is reported without an appropriate primary code.

8. Historical information

CPT 96367 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition. Prior to 2012, the code description was slightly different, but it was revised to its current description on January 1, 2012.

9. Examples

1. A provider administers an additional infusion of a different medication to a patient for up to one hour to treat a specific condition.
2. A patient receives an initial infusion of a medication, and later, a different medication is administered as an additional infusion for up to one hour to prevent a certain disease.
3. A provider administers an additional infusion of a different substance to a patient for up to one hour to diagnose a particular condition.
4. After an initial infusion of a medication, a provider administers an additional infusion of a different medication to a patient for up to one hour to manage their symptoms.
5. A patient receives an initial infusion of a substance, and later, a different substance is administered as an additional infusion for up to one hour to monitor their response to treatment.
6. A provider administers an additional infusion of a different medication to a patient for up to one hour to alleviate their pain.
7. After an initial infusion of a medication, a provider administers an additional infusion of a different medication to a patient for up to one hour to improve their overall health.
8. A patient receives an initial infusion of a substance, and later, a different substance is administered as an additional infusion for up to one hour to manage their chronic condition.
9. A provider administers an additional infusion of a different medication to a patient for up to one hour to prevent complications related to their disease.
10. After an initial infusion of a medication, a provider administers an additional infusion of a different medication to a patient for up to one hour to enhance the effectiveness of their treatment.