Q&A: CPT coding for a drug infused twice though the same line

Q: If a patient comes in twice a day over the course of a week to receive an IV infusion of Vancomycin and the same line is used daily, would the coder report one initial infusion CPT code per day?

A: Yes— if a patient comes in twice a day and the provider uses the same line from one day to the next, the coder would report one initial code per calendar day. He or she would report the primary code for the first hour of the infusion and add-on codes for any subsequent hours of infusion administration.

CPT codes used to describe initial IV infusions for therapy, prophylaxis, or diagnosis include:

• 96365, IV infusion, for therapy, prophylaxis, or diagnosis; initial, up to one hour
• Add-on code 96366, …; each additional hour
• Add-on code 96367, …; additional sequential infusion of a new drug/substance, up to one hour
• Add-on code 96368, …; concurrent infusion

Per the CPT guidelines, only one initial service should be reported for a given IV site location per date of service unless protocol requires that two separate IV sites be used. If a separate IV line was started, the second IV site access site would be reported using the initial service code with modifier -59 (distinct procedural service).  

Editor’s note: Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior coding educator at Healthcare Information Services in Park Ridge, Illinois, answered this question during the HCPro webinar, Oncology Overview: Outpatient Coding for Neoplastic Diseases and Drug Administration.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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