Forum - Questions & Answers
Is 96365 a physician code or hospital code?
My son went to the ED at college for a fever and dehydration. We got a bill from the hospital that included a $475 charge for IV therapy (no CPT) and then the ED doctor bill arrived with a charge for the visit 99284 and IV therapy with meds 96365. I am trying to figure out if the doc is allowed to charge the IV therapy code 96365 for ordering and supervising the IV infusion that was provided by the hospital.
Place of service
The hospital will bill. E.D. Physicians are not paid for these codes 96365-96368, in ED (Medicare).
96365
Wow, $475 dollars for an IV infusion? The RVUs for that code are 1.85, giving it a national fee schedule amount of $66.76.
The physician can't bill for it, since he doesn't pay the nurse, buy the supplies or do the work.
The hospital can bill for it, but the charge seems way out of whack. Is that the entire facility charge, or just for the IV infusion?
I assume there was no expensive medicine in the infusion.
thanks for your replies
The hospital charged $475-IV only, total bill was ~$1600 there was no breakdown of what was in the IV- maybe potassium. The insurance adjustment was down to $600 or so for the whole visit- my kid is worth that so I paid, and how can I complain when I work at a hospital that charges similar rates?
But I am going to fight the doctor bill- first of all the flu is not a level 4 ED visit and they should not be charging for the IV therapy- maybe this is my chance for a qui tam lawsuit.
99284
Requires lower level documentation that 99204. It requires:
Detailed history (4 HPI elements, 2-9 ROS, 2 of PFSH
Detailed exam: 12 bullets from 1997 exam
Moderate MDM.