How Infusion Billing Company Helps with CPT Code 96413

According to ASCO Publications, the national median commercial price for CPT 96413 is $536. Moreover, CMS says CPT code 96413 is for the first chemotherapy administration. This shows why this code is important. They also need to care for their patients at the same time. That’s where an outsourced infusion billing company can assist you. But before diving into how they can help, let’s find out about the CPT codes in detail.

Overview of CPT Code 96413

The CPT 96413 code is used for the initial IV chemotherapy infusion or other drugs, that are administered over a period of 15 minutes. It covers drug administration, documentation, and monitoring to ensure claims are not denied. Hence, using this code correctly helps clinics streamline revenue and stay CMS compliant with the help of outsourced infusion billing.

Real-World Applications

You need to know that correct coding helps clinics get proper reimbursement. However, mistakes like missing start/stop times or wrong drug documentation can cause claim denials. This is where an infusion billing company plays a key role, meticulously handling claim preparation and denial management.

Related Reading: The Real Cost of Missing Add-On Codes in Infusion Billing

Comparison with 96365 and 96374

A lot of providers still don’t understand the difference between CPT code 963413 and newer codes like 96365 and 96374, thus mixing them up and facing denials. You need to understand that 96365 is used for non-chemo drugs and 96374 for sequential IV infusions. However, miscoding can significantly lead to underpayment and denials. Hence, understanding these differences may lead to accurate billing and compliance procedures. These outsourcing infusion billing services assign codes correctly based on drug type, order, and infusion timing. So, this comparison portrays an essential role in understanding all the latest requirements which can streamline the claim submission process.

Compliance and Billing Considerations

Billing for this code needs strict adherence to accurate documentation, payer rules, and compliance with coding standards. Common billing errors include missing infusion times. Hence, these mistakes can create denials and delayed payments. Billing companies provide end-to-end RCM services which ensure claims meet the requirements of commercial payers. These experts track infusion timing, verify the documentation process, and handle appeals effectively. This lets healthcare staff focus on patients instead of handling billing and paperwork.

Coding Challenges with IV Infusion

IV infusion billing is not easy, as the main challenge is choosing the right code between initial and subsequent infusions. Providers must record start and stop times clearly. They also need to note the drug type and how it was given. Insurance rules and NCCI bundling make it even more complex, as a small mistake in documentation can cause denials or lower payments. Many clinics mix up chemotherapy and also non-chemotherapy codes, hence causing massive revenue loss for chemotherapy infusion billing.

How 96413 Interacts with 96360 and 96375

CPT 96413 billing is used for the infusion of other complex drugs. CPT 96360 is used when the first infusion is for hydration. CPT 96375 gives an extra IV infusion coding of a different drug. Missing notes or choosing the wrong code can cause denials. The timing and order of infusion are also very important. Only one initial code can be billed per session unless a separate IV line is initiated. A professional infusion billing company uses the right codes to make sure no claim denial occurs.

Tips for Successful Reimbursement

Providers must track time correctly to get paid faster for CPT 96413. They should note start and stop times clearly, and the drug type must match the correct CPT code. It’s also important to check the rules of each insurance payer. Medicare and commercial plans follow different bundling rules, which is why regular internal audits help catch mistakes early. Working with an expert infusion billing company improves accuracy.

Avoiding Coding Mistakes with 96413

Common mistakes with CPT 96413 include using it for non-chemotherapy drugs or missing time details. Some providers also bill more than one initial code or mix it up with hydration codes. A skilled infusion billing company checks every claim before it is sent. However, the question now is: how do you select the right billing company for your clinic? As there are so many RCM companies out there, which one to choose? That’s where SunKnowledge comes in as your trusted partner.

Related Reading: Simplify Your Infusion Billing with Powerful Practices

SunKnowledge: Your Reliable Infusion Billing Company

There are several types of infusion therapies, including Intravenous, Epidural, Subcutaneous, and Intramuscular, and SunKnowledge excels in accurate billing for all of them. We also handle billing for drugs such as antibiotics, antifungals, corticosteroids, insulin, biologics, chemotherapy, and blood factors. Our experts provide timely delivery of charge sheets, and they hold ICD-10 certifications, which showcase their proficiency and expertise. We maintain a 99.9% accuracy rate and are fully HIPAA compliant. SunKnowledge also provides comprehensive pre-billing services which include eligibility verification, prior authorization, medical coding, and many more. The post-billing services also include claim creation, submission, rejection management, and many more. So, if you want to streamline your billing process, it may be a feasible option to outsource an infusion billing company like SunKnowledge.

So, take the step today and see your clinic reach new heights.

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