Infusion therapy is one of the most effective methods for drug administration. It refers to delivering drugs or substances via a needle or catheter, typically intravenously (IV), straight into the bloodstream, avoiding the digestive tract because some medicine loses their potency when they come into contact with the digestive tract.
CPT code 96366 reports the same method of drug/substance administration. Continue reading this blog to learn more about this code, including its description, applicable modifiers, billing guidelines, and the clinical scenarios where it can be reported.
CPT Code 96366 Description
CPT 96366 is an add-on code. It is reported with the primary CPT code 96365. The only difference between the two codes is that 96365 reports intravenous drug/substance infusion for the initial hour, whereas CPT code 96366 reports each additional hour of IV infusion for therapeutic, prophylactic, or diagnostic purposes.
You must keep in mind that code 96366 does not cover infusion therapy of advanced drugs or highly complex biologic agents like chemotherapy/anti-cancer medications. Furthermore, this code is used in combination with its primary code – 96365
Appropriate Use Cases for CPT Code 96366
For a better understanding of the CPT code 96366, below are some scenarios where this code is most accurately applicable:
IV Fluids for Rehydration
Suppose a person has been suffering from diarrhea for the last 24 hours. Due to this condition, he is experiencing severe dehydration, which requires him to receive IV fluids containing electrolytes to rehydrate his body. The infusion lasts longer than 60 minutes or requires more than 1 hour of the dose. In this case, you will use CPT code 96366 to bill for the additional hours.
IV Antibiotics for Cellulitis
Let’s suppose a 55-year-old man has expanding spots on his left leg with severe itching and irritated skin. Upon check-up, it turned out to be severe cellulitis, which required immediate IV infusion of vancomycin. Since the patient receives an IV infusion of vancomycin for 120 minutes (which is more than 1 hour), you will report CPT code 96366.
Thrombocytopenia in Pregnancy
Women are more commonly diagnosed with platelet disorders during pregnancy because screening is done as part of the initial clinical evaluation with automated blood counts. Suppose a woman requires IV infusion to manage thrombocytopenia (low platelet count) during pregnancy for more than an hour. You will use CPT code 96366 for each additional hour beyond the first.
Reimbursement Guidelines for CPT Code 96366
Follow these billing and reimbursement guidelines specific to code 96366 to submit accurate and timely claims.
Use to Report An Additional Hour
CPT code 96366 is an additional or sequential code of CPT code 96365. It identifies therapeutic, prophylactic, or diagnostic nonchemotherapy drug infusion or injection when provided as a secondary or subsequent service. The physician will report CPT code 96366 if the infusion therapy lasts for another 30-60 minutes beyond the first hour.
Use in Combination with the Primary Code
CPT code 96366 is an add-on code and must be reported with its primary code – CPT 96365.
To keep things simple, let’s say the patient receives a medication infusion for two hours and thirty minutes. The provider will report code 96365 for the first hour and must bill 96366 with the first code for the remaining 1 hour and 30 minutes.
Do Not Use Modifiers
Modifiers are not required with CPT code 96366 because it is an add-on code. Typically, modifiers should not be used with add-on codes because the code itself indicates that it is a secondary service with a discounted fee. Instead, modifiers should be used with the principal IV infusion code 96365, if needed.
Provide Detailed Documentation
You must fulfill all the documentation requirements to receive fair payments for your services. The following is a list of the documents you must attach to the claim form:
- The patient’s complete medical record
- Patient’s examination reports or diagnostic test reports
- Clinical notes that clearly mention the duration of infusion therapy
- The dosage name and amount
Final Thoughts on CPT Code 96366
CPT code 96366 is an additional code. It is reported in conjunction with the primary intravenous infusion service (CPT code 96365). The code reports every extra hour of IV infusion of a drug or substance for treatment, prevention, or diagnosis.
However, this code should not be used for the infusion of complex biologic agents and chemotherapy drugs. Also, since CPT 96366 is an add-on code, there is no need to apply any modifier for billing.
It is best that your practice acquires professional medical billing and coding services from third parties to simplify the billing process. Outsourcing allows you to focus on your core tasks instead of worrying about coding, documentation, and reimbursement collection.
