Therapeutic, Prophylactic, or Diagnostic Intravenous Injection Targeted Probe and Educate Review Results - JE Part A
Therapeutic, Prophylactic, or Diagnostic Intravenous Injection Targeted Probe and Educate Review Results
The Jurisdiction E, Part A Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of for Current Procedural Terminology (CPT®) code 96374 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug. The findings of the claims reviewed from July 1, 2024 through September 30, 2024 are as follows:
Review Results
- 135 claims were reviewed with 18.68% error rate
Top Trending Errors
- Therapeutic Administration Billing Integral to a Procedure
- Documentation Requirements of Therapeutic, Prophylactic or Diagnostic Injection, Intravenous Push, Single or Initial Substance/Drug
- Billing/Coding of Therapeutic, Prophylactic or Diagnostic Injection, Intravenous Push, Single or Initial Substance/Drug
Educational Resources
- CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 230.2 B
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.5
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 17
Education
Therapeutic Administration Billing Integral to a Procedure
Per Current Procedural Terminology (CPT®) manual, IV pushes or IV infusions integral to a procedure, such as contrast material for imaging, should not be billed. This would include CPT® codes 96365-96379.
Documentation Requirements of Therapeutic, Prophylactic or Diagnostic Injection, Intravenous Push, Single or Initial Substance/Drug
Per guidelines found in the Current Procedural Terminology (CPT®) manual, when reporting codes for which infusion time is a factor, use the actual time over which the infusion is administered. The CPT® manual includes descriptors and guidelines when billing codes for hydration, chemotherapy, infusion, or injections. In order to evaluate the actual time of a hydration or infusion/injection services, it is important that the medical record include either documentation of the total infusion time OR both the start time, when the infusion starts dripping, and the stop time, when the infusion stops dripping, to support the services billed.
Billing/Coding of Therapeutic, Prophylactic or Diagnostic Injection, Intravenous Push, Single or Initial Substance/Drug
Per the Current Procedural Terminology (CPT®) manual, therapeutic infusions should be billed for infusions lasting 16 minutes up to one hour with CPT® 96365. Report 96366 for infusion intervals of greater than 30 minutes beyond 1-hour increments. CPT® 96374 should be billed for an intravenous push, single or initial substance/drug, infusions for durations of 15 minutes or less.
