When to Use CPT 96368 in Infusion Therapy and Drug Administration

When it comes to infusion therapy billing, precision is a must, from start to finish. CPT 96368 is one code that can trip up healthcare professionals. It is important for everyone, from nurses to physicians to billing professionals, to recognize and apply this code at the right time and place to ensure that you don’t lose out on your revenue and keep your claims clean. CPT code 96368 is explained in a professional yet easy-to-understand manner that your team can confidently and accurately use for billing.

 

What Is CPT 96368 in Infusion Billing Explained

CPT 96368 is an injection and infusion code that is used for both therapeutic and prophylactic treatments, as well as for diagnostic purposes. In particular, it is used for concurrent infusion, which is defined as the simultaneous use of a second or third infusion medication. The important word is concurrent, the drugs are flowing in the same or other line at the same time.

This code will be reported only for the first infusion(s) administered during the visit. It’s an add-on code, meaning it can’t be billed independently. It should always be reported with a main infusion code like CPT 96365, or CPT 96413. Knowing the details of CPT code 96368 from the start can save your billing team from denials and costly mistakes, ensuring that each drug administered appears on the claim properly.

 

CPT 96368 Guidelines for Concurrent Drug Administration Billing

There are clear guidelines for use of CPT 96368 from the American Medical Association and key payers. The concurrent infusion is separate from the main infusion and also both infusions must be administered concurrently at the time of meeting.

Your team needs to keep these billing rules in mind:

• CPT 96368 is only reported once for the same date of service regardless of the number of drugs given during the infusion.
• It is always used in addition to a main infusion code and should be used in conjunction with it.
• The other drug to be given concurrently must be documented in the medical record.
• The time of beginning and ending each infusion should be documented in the nursing notes or infusion flow sheet.
• When the drug is used on a sequential basis (one at a time), CPT code 96368 is not applicable.

In that case, sequential codes such as CPT 96367 would be more suitable. One of the most frequent billing mistakes that can occur in infusion therapy environments is the use of the wrong code.

 

When to Report CPT 96368 With Other Infusion Codes

It is essential to understand when to use 96368 in conjunction with other CPT codes when submitting a claim. This code is always the second code on the primary infusion code. 96368 codes for the concurrent use of the additional drug, and the primary code codes for the primary infusing drug. For example, if a patient receives a hydration drug or an antiemetic concurrently with a CPT 96413 infusion of chemotherapy, then 96368 should be reported along with CPT 96413.

96368 may be used with other code(s) from the same or multiple therapeutic drugs that are administered at the same time as hydration such as CPT 96360. But, if a service is more complex than hydration, it cannot be the primary code in the same encounter. Use clinical documentation as a guide for coding.

 

CPT 96368 vs Sequential Infusion Codes Key Differences

There are a lot of billing professionals out there who are confusing CPT code 96368 with sequential infusion codes (particularly CPT 96367). The two codes differ in their timing of administration. Side by side comparison:

Feature	CPT 96368	CPT 96367
Infusion Timing	Drugs run at the same time	Drugs run one after the other
Code Type	Add-on code	Add-on code
Times Reported Per Encounter	Once only	Multiple times if applicable
Clinical Scenario	Concurrent drug administration	Sequential drug administration
Common Pairing	CPT 96413, CPT 96365	CPT 96413, CPT 96365

When these two codes are mixed together or used in the wrong manner, it may lead to audit and claim denials or requests for overpayment from payers. Be sure to analyze the infusion flow sheet prior to choosing the correct code.

 

Common CPT 96368 Billing Errors Providers Must Avoid

There are such blindingly obvious mistakes with 96368, even for experienced billing teams. The most frequent mistakes that result in revenue loss and denials are as follows:

• Always use it in conjunction with an infusion code: Billing 96368 as a stand alone code. If it is sent without an application, it will be automatically refused.
• CPT 96368 reported more than once per encounter: Some billers mistakenly use this code for each concurrent drug administered, but the guidelines state that it needs to be reported only once per date of service.
• Failure to document: If the medical record is not properly documented to show that two drugs were administered concurrently, then the claim may be denied or flagged during an audit.
• Start and stop times must be documented: The start and stop times for all drugs should be documented. If they’re not there, they won’t be able to confirm the infusion is concurrent.
• CPT 96368 for sequential infusions: This is a coding error that can cause significant compliance issues if this code is used when drugs were administered one at a time instead of at the same time.

Before any claim is submitted for CPT code 96368, always review the nursing notes and infusion flow sheets.

 

Payer Rules That Affect CPT 96368 Reimbursement Rates

CPT 96368 has different rules among various payers. Medicare, Medicaid, and most commercial insurance plans may have different policies regarding reimbursements and documentation requirements. CPT code 96368 is paid as an add-on code, according to the Centers for Medicare and Medicaid Services guidelines. Medicare reimburses a facility rate, a non-facility rate and the reimbursement for the concurrent infusion is typically less than the reimbursement for the primary infusion code.

Some commercial payers may require prior authorization for certain drugs billed under CPT code 96368. Others may “wrap” the concurrent infusion payment into the main code, which will not be a separate payment for CPT code 96368. Never assume policies that are unique to the payer without checking first; you may be denied a claim. Billing teams need to check their state-specific Medicaid guidelines as these can differ from state to state. This is one of the most frequent causes of denied/late claims for infusion therapy practices.

 

Documentation Requirements for Accurate CPT 96368 Claims Submission

All successful infusion billing claims begin with strong documentation. If CPT code 96368 is used, documentation of a concurrent infusion must be clearly documented in the medical record. A clean claim must include the following documentation:

• Drug name: The name of each drug administered must be clearly listed in the medical record.
• Start/Stop times: Each drug’s start/stop time should be documented in the infusion flow sheet or the nursing notes.
• Route of administration: The way in which each drug is administered should be recorded.
• Physician order: The order must be given by the physician who administered the drugs and it must be there and clearly related to the drugs administered.
• Concurrent timing confirmation: Record both drugs were infused during the same encounter.

As with correct coding, it is crucial to train clinical staff on correct infusion documentation. While documentation can be captured through an electronic health record system, manual review prior to claim submission is always recommended as a way to ensure no documentation is missing.

 

How Infusion Billing Services Optimize CPT 96368 Revenue?

Partnering with a professional infusion billing service can make a significant difference in how accurately and efficiently your CPT code 96368 claims are handled. Billing for infusions is a particular niche specialty and the teams that handle general medical billing may not have the expertise to correctly process infusion claims.

A dedicated infusion billing service will ensure that each claim is paired correctly, that documentation justifies each code billed and that the infusion billing service keeps up to date with payer policy changes that impact reimbursement. They also conduct regular audits to detect billing mistakes before claims are filed. Infusion Billing Services is dedicated to the infusion therapy providers’ needs alone. The point is to get the most reimbursement possible and remain completely compliant with payers and regulatory guidelines from CPT 96368 through complex chemotherapy codes. With the right billing partner, your team can focus on patient care while the billing side runs smoothly and profitably.

 

Conclusion

Although CPT 96368 is critical to infusion billing, this code must be monitored closely. Whether or not you understand its meaning and when to utilize CPT 96368 along with other codes, receiving this code right can assist you from losing revenue and avoid any compliance issues. Avoiding usual errors, following the payment rules, having proper documentation and utilizing billing services can guarantee to receive well payment in correct claim submission. Whether you are in need of infusion billing codes like CPT 96368 or other codes, Infusion Billing Services will have all the resources necessary to support your team through this difficult task.

 

Frequently Asked Questions

Who can bill CPT 96368 in medical billing?

96368 can be billed by medical providers, such as hospitals, infusion centers, and physician practices, when concurrent infusion services have proper documentation and are medically necessary.

Is CPT 96368 used for chemotherapy infusions?

96368 may be applicable during a chemotherapy visit when a non-chemotherapeutic drug is infused simultaneously with the principal chemotherapy drug and all billing requirements are met.

Does CPT 96368 require start and stop times?

Yes, the start and stop times for 96368 are vital. A missing or improper infusion start and stop time usually causes errors, payments delays, and claim rejections.

Can CPT 96368 be billed with hydration therapy?

Yes, CPT code 96368 may be billed with hydration therapy when the concurrent infusion meets the requirements set by the payer and the separate medical necessity for both treatments can be justified through documentation.

Why do insurance companies deny CPT 96368 claims?

Insurances may deny claims that report CPT code 96368 due to a missing record for documentation of simultaneous administration, improper coding for the services, or redundant claim submission, and failure to establish the use of concurrent infusions.

Is modifier usage required with CPT code 96368?

Sometimes modifiers are necessary based on payer guidelines and specific circumstances. Physicians should consult payer-specific billing guidelines for submission of CPT 96368.

Can outpatient facilities report 96368 cpt code?

Yes, outpatient facilities will also report 96368 cpt code for concurrent infusions given to a patient and all required coding and documentation criteria have been met.

What type of infusion qualifies for CPT 96368?

96368 cpt code applies to concurrent infusions, where two different drugs are simultaneously infused within the same patient encounter under a physician's supervision.

How can providers avoid CPT code 96368 billing mistakes?

To avoid billing mistakes with CPT 96368, healthcare professionals need to document all infusions, confirm that the code used corresponds with the infusion services given to the patient, review the payer's policy, and periodically conduct a medical coding audit.

Why is accurate CPT 96368 billing important?

Accurate CPT 96368 billing will help prevent the insurance companies from denying claim submissions, will maintain compliance within the medical provider's office, increase the rates of reimbursement, and shorten payment delays caused by incorrect billing.