Compliance Question of the Week – General

Do you have any tips regarding medical necessity and secondary intent?

When calculating the time for hourly increments of infusion, what specific periods should be excluded from the time interval, and why are pre- and post-infusion services not separately billable?

What distinguishes the administration of fluids reported with codes 96360 and 96361 from therapeutic, diagnostic, and prophylactic drug administration, and what level of patient risk is typically associated with hydration therapy?

Under what circumstances can CPT® code 36415 for venipuncture be reported separately on an outpatient claim, and how does Medicare’s OPPS status indicator Q4 impact the packaging of this service?

A patient is receiving an infusion treatment in which three different medications are administered simultaneously through a multi-lumen IV line. According to the AMA CPT guidelines, would this scenario be coded as a concurrent infusion (CPT 96368), and what key factors should be documented to support this code? Additionally, how would coding differ if the medications were mixed in a single bag instead of administered through separate IV piggy-backs?

How should an IV infusion lasting 2 hours and 10 minutes be billed if no additional infusion hour is warranted? Should an IV push charge be reported for the additional 10 minutes of the infusion?

Under what circumstances does Medicare provide coverage for drugs or biologicals, and how is the determination made regarding whether a drug is considered “not usually self-administered”?

How should the administration of an IV infusion lasting longer than 1 hour but less than 91 minutes be reported? At what point should the code 96415 be used for “each additional hour” of infusion?

How should the administration of an IV infusion lasting longer than 1 hour but less than 91 minutes be reported? At what point should the code 96415 be used for “each additional hour” of infusion?

Will reporting codes 96372 and 96373 be impacted by the determination of the primary or secondary intent of the encounter?

What criteria must be met when using 96374 with 96375?

What codes do we report for monoclonal antibody Beyfortus™?