How To Use CPT Code 96369

CPT 96369 describes the subcutaneous infusion for therapy or prophylaxis, including pump set-up and establishment of subcutaneous infusion site(s), 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 96369?

CPT 96369 can be used to describe the subcutaneous infusion of a medication or substance for therapy or prophylaxis. This code includes the set-up of an infusion pump and the establishment of subcutaneous infusion site(s). The infusion lasts for up to one hour and is administered by a healthcare provider.

2. Official Description

The official description of CPT code 96369 is: ‘Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s).’ This code is used when a healthcare provider administers a medication or substance subcutaneously for therapeutic or preventive purposes, using an infusion pump and establishing the necessary infusion site(s).

3. Procedure

1. The healthcare provider discusses the need for the subcutaneous infusion with the patient or their family, explaining the purpose and what to expect.
2. The provider examines the intended insertion site and inserts a catheter just under the patient’s skin, securing it in place.
3. The provider verifies the dosage of the medication or substance and compares it to the patient’s orders.
4. The provider prepares the substance for infusion and loads it into an infusion pump or syringe driver.
5. The provider sets the appropriate infusion rate for delivery and initiates the subcutaneous infusion.
6. The initial infusion continues for a period of up to one hour.

4. Qualifying circumstances

CPT 96369 is used for patients who require subcutaneous infusion therapy or prophylaxis. The medication or substance being infused should be specified. This code is appropriate for therapeutic or preventive purposes. The healthcare provider must set up the infusion pump and establish the necessary subcutaneous infusion site(s).

5. When to use CPT code 96369

CPT code 96369 should be used when a healthcare provider administers a subcutaneous infusion for therapy or prophylaxis, including pump set-up and establishment of subcutaneous infusion site(s), for up to one hour. This code is not appropriate for infusions lasting less than 15 minutes. If the infusion lasts for more than one hour, additional codes should be used.

6. Documentation requirements

To support a claim for CPT 96369, the healthcare provider must document the following information:

• The specific medication or substance being infused
• Date and duration of the infusion
• Details of the pump set-up and establishment of subcutaneous infusion site(s)
• Any relevant patient information or instructions provided
• Signature of the healthcare provider administering the infusion

7. Billing guidelines

When billing for CPT 96369, ensure that the infusion is administered by a healthcare provider and includes pump set-up and establishment of subcutaneous infusion site(s) for up to one hour. This code should not be reported for infusions lasting less than 15 minutes. If the infusion lasts for more than one hour, additional codes should be used. It is important to specify the medication or substance being infused in the documentation.

8. Historical information

CPT 96369 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 healthcare provider administers a subcutaneous infusion of pain medication for up to one hour to a patient with chronic pain.
2. A nurse sets up an infusion pump and establishes subcutaneous infusion site(s) to administer a preventive medication for up to one hour to a patient at risk for a specific condition.
3. A physician administers a subcutaneous infusion of a therapeutic substance for up to one hour to a patient with a chronic illness.
4. A healthcare provider initiates a subcutaneous infusion of a prophylactic medication for up to one hour to a patient before a surgical procedure.
5. A nurse prepares and administers a subcutaneous infusion of a therapeutic substance for up to one hour to a patient with a specific medical condition.
6. A healthcare provider establishes subcutaneous infusion site(s) and administers a preventive medication for up to one hour to a patient at risk for a particular disease.
7. A nurse sets up an infusion pump and administers a subcutaneous infusion of a therapeutic substance for up to one hour to a patient with a chronic condition.
8. A physician initiates a subcutaneous infusion of a prophylactic medication for up to one hour to a patient before a medical procedure.
9. A healthcare provider administers a subcutaneous infusion of a therapeutic substance for up to one hour to a patient with a specific medical condition.
10. A nurse prepares and administers a subcutaneous infusion of a preventive medication for up to one hour to a patient at risk for a particular disease.