Infusion for therapeutic, prophylactic, or diagnostic purposes
CPT® Code 96365 is used to report the administration of intravenous (IV) infusion therapy for therapeutic, prophylactic, or diagnostic purposes. This code applies when a single drug, substance, or biological agent is administered via IV infusion lasting up to 1 hour in the outpatient or similar clinical setting.
When to use CPT® Code 96365
This code is appropriate when:
- The patient receives a therapeutic, prophylactic, or diagnostic IV infusion that lasts up to 1 hour.
- The infusion is for a single drug or substance, such as antibiotics, fluids, biologics, or other medications.
- The administration takes place in an outpatient setting or another appropriate setting like a clinic.
- The service does not require any additional infusions or the administration of additional medications during the same encounter (use CPT 96368 for additional infusions).
Common examples include:
- Therapeutic infusions, such as antibiotics, pain medications, or biologics.
- Prophylactic infusions, such as immunoglobulin or vaccines.
- Diagnostic infusions, like contrast agents used for imaging.
Administration and time requirements
For CPT 96365 to be used, the following conditions must be met:
- The IV infusion must last up to 1 hour from start to finish.
- The specific drug, substance, or biological administered must be documented.
- The time spent on the infusion must be documented clearly, including the total infusion duration and the start and end times.
Key documentation tips
- Document the start and end times of the infusion accurately, ensuring the total time does not exceed 1 hour for this code.
List the drug or substance being infused, as this provides necessary context for the administration. - Monitor the patient during the infusion for any reactions, and document any monitoring procedures (e.g., vital signs) to reflect the complexity of the visit.
- If multiple infusions are provided during the same encounter, use CPT 96368 to report additional infusions.
How OptiMantra supports accurate coding for CPT® 96365
OptiMantra provides tools and features designed to make the documentation and billing for procedures like CPT 96365 seamless, accurate, and efficient. Here’s how OptiMantra helps:
- Automated time tracking: Accurately logs the start and end times of the infusion to ensure the total time is correctly recorded for proper coding.
- Infusion documentation templates: Guides the provider through the required documentation for infusions, including drug/substance details, time, and patient monitoring.
- Real-time coding assistance: Offers intelligent suggestions based on entered data to ensure correct code selection (e.g., 96365 for a single infusion up to 1 hour).
- Streamlined billing workflows: Integrates clinical documentation with the billing system, reducing coding errors and expediting claims submission.
- Audit-ready records: Keeps detailed logs of infusion times, medications administered, and monitoring steps, ensuring compliance with payer requirements.
By using OptiMantra, healthcare providers can ensure they accurately capture the services provided, reduce the risk of billing errors, and stay compliant with both coding standards and payer guidelines.
Try OptiMantra for free here!
