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The CPT® Code 96371 refers to the process of subcutaneous infusion for therapy or prophylaxis, specifically when an additional pump set-up is required along with the establishment of new subcutaneous infusion site(s). This code is utilized when a healthcare provider needs to set up a new infusion site after the initial procedure has been performed, which is typically coded under CPT® 96369. The procedure involves the careful preparation and administration of a substance or drug through a subcutaneous route, which is the layer of tissue just beneath the skin. This method is often chosen for its ease of access and the ability to provide continuous medication delivery over a specified period. The infusion process requires strict adherence to aseptic techniques to prevent infection and ensure patient safety. The healthcare provider must select appropriate sites for infusion, which may include areas such as the abdomen, upper buttocks, lateral thigh or hip, and upper arm. Each site is meticulously prepared and tested to confirm proper placement before the medication is administered. This code is particularly important for billing purposes, as it allows for the documentation of additional resources and time spent in setting up new infusion sites beyond the initial procedure.
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The CPT® Code 96371 is indicated for use in situations where a patient requires ongoing therapy or prophylaxis through subcutaneous infusion, and there is a need for additional pump set-up with the establishment of new infusion site(s). This may include patients who are receiving medications that necessitate continuous delivery for conditions such as chronic pain management, hydration therapy, or other therapeutic interventions that benefit from subcutaneous administration.
The procedure associated with CPT® Code 96371 involves several critical steps to ensure the safe and effective administration of the prescribed substance or drug. First, the healthcare provider prepares the necessary equipment, including a sterile syringe and needle, to withdraw the prescribed amount of medication. The pump reservoir is then filled, and the pump along with the tubing is prepared for use. Next, the provider selects the number and location of the infusion sites based on the total dosage of the medication to be administered. Common sites for subcutaneous infusion include the abdomen, upper buttocks, lateral thigh or hip, and upper arm. Each selected site is prepped with an antiseptic solution to minimize the risk of infection. Following this, a needle is inserted into the subcutaneous tissue at each site, and the placement is verified by pulling back on the syringe to check for blood flow, ensuring that the needle is not in a blood vessel. Once confirmed, each needle is secured with tape to maintain its position. After all infusion sites are secured, the medication is administered through the pump, allowing for controlled delivery of the drug over the specified duration.
After the procedure coded under CPT® 96371, the patient may be monitored for any immediate reactions to the medication administered. It is essential to ensure that the infusion sites remain clean and dry to prevent infection. The healthcare provider may provide instructions on how to care for the infusion sites and what signs of complications to watch for, such as redness, swelling, or unusual pain at the site. Follow-up appointments may be scheduled to assess the effectiveness of the therapy and to make any necessary adjustments to the treatment plan. Additionally, documentation of the procedure, including the substances used and the sites of infusion, is crucial for accurate billing and compliance purposes.
| Short Descr | SC THER INFUSION RESET PUMP | Medium Descr | SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE | Long Descr | Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 231 - Other therapeutic procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96369 | MPFS Status: Active Code APC S Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | CR | Catastrophe/disaster related | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
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