General Question for the Week of January 13, 2025

Question:

Do you have any examples or tips for reporting 96365 vs 96366 in 2025?

Answer:

The hierarchy for facility reporting permits the reporting of code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour) for the first one-hour dose administered with add-on code 96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) being used for the second and third one-hour infusions of the same drug. The three doses of the same antibiotic will be reported as follows:

Report code 96365 for the first dose (7:00 am)

Report add-on code 96366 x1 for the second dose (3:00 pm)

Report add-on code 96366 x1 for the third dose (11:00 pm)

In this scenario coders and charge capture staff will need to ensure start and stop times are present and the time requirements have been met for reporting 96366 in multiple units. Remember to qualify reporting of codes 96365 and 96366 a minimum time requirement is 16 minutes of infusion time must be documented for each separately prepared/hung IV bag. To report more than 1 unit for the same drug administered (same bag), at least 91 minutes must be met to report code 96366 x2 units.

This question was answered in our Coding Essentials for Infusion & Injection Therapy Services. For more hot topics relating to infusion services, please visit our store or call us at 1.800.252.1578, ext. 2.