KETAMINE INFUSION MEDICAL TREATMENT CODES 1/1/2013
FOR TREATING CRPS WITH BOTH IN-PATIENT LOW-DOSE INFUSION
AND THE HIGHER DOSE OUT-PATIENT INFUSION TECHNIQUES
Here are the Medical Billing Codes that are supposed to be used when submitting claims for treating CRPS with the KETAMINE INFUSION PROCEDURE; as we understand them to be as of 1/1/2013. If anyone has any updates and/or changes to these please send them to American RSDHope.
We have included the coding numbers for both the Low-Dose Ketamine Infusion method (first pioneered by Dr Ronald Harbut in the United States), as well as the higher dose out-patient Ketamine Infusion method. Doctor Ronald Harbut (now treating patients in Iowa), as you can read in the articles in this section above and the accompanying articles, first worked with Dr Correll in Australia treating pain patients with ketamine. Dr Harbut then came to the United States and started treating CRPS patients in 2002 using the Low-Dose in-patient Ketamine Infusion method. He was also the first Doctor to work with the FDA in getting a ketamine protocol approved for the low-dose method.
Later in 2003 he traveled to Philadelphia, PA where he shared/trained some of the Doctors there in his methodology and treatment methods. Since then, many Doctors all over the country have begun treating patients using both treatment methods and have even added two additional methods.
(see notes regarding these codes at the bottom of this section)
note - if you link to this information, please link to the actual url above and do not just copy the information. Thank you American RSDHope.
We have included the coding numbers for both the Low-Dose Ketamine Infusion method (first pioneered by Dr Ronald Harbut in the United States), as well as the higher dose out-patient Ketamine Infusion method. Doctor Ronald Harbut (now treating patients in Iowa), as you can read in the articles in this section above and the accompanying articles, first worked with Dr Correll in Australia treating pain patients with ketamine. Dr Harbut then came to the United States and started treating CRPS patients in 2002 using the Low-Dose in-patient Ketamine Infusion method. He was also the first Doctor to work with the FDA in getting a ketamine protocol approved for the low-dose method.
Later in 2003 he traveled to Philadelphia, PA where he shared/trained some of the Doctors there in his methodology and treatment methods. Since then, many Doctors all over the country have begun treating patients using both treatment methods and have even added two additional methods.
(see notes regarding these codes at the bottom of this section)
note - if you link to this information, please link to the actual url above and do not just copy the information. Thank you American RSDHope.
KETAMINE IV MEDICAL BILLING CODES
KETAMINE IN-PATIENT MEDICAL BILLING CODES
99223 Initial Hospital Services Level 3 H&P Day 1
99255 Level 5 Hospital Consult Day 1
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour Day 1
99295 Initial Inpatient, Intensive Care Unit, Room& Board, Incidentals Day 1
76499 Chest X-Ray Reading Day 2
99233 Level 3 Progress Note Day 2
99222 Level 3 Progress Note Day 3
99255 Level 5 Hospital Consult Day 3
99252 Level 2 Hospital Consult Day 4
99255 Level 5 Hospital Consult Day 4
99233 Level 3 Progress Note Day 5
99252 Level 2 Hospital Consult Day 5
(some physicians do the in-patient treatment for five days, some do seven and some vary the treatment depending on how the patient is responding to the treatment)
99233 Level 3 Progress Note Day 6
99255 Level 5 Hospital Consult Day 6
99255 Level 5 Hospital Consult Day 7
Lab Services Day 1-7
96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) Day 1-7
90774 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug Day 1-7
99295 Inpatient, Intensive Care Unit, Room& Board, Incidentals, Subsequent Care Day 1-7
J3490 Unclassified drug (use for Ketamine) Day 1-7
We do not know if there is a separate billing code for the pre-testing most physicians require prior to being accepted into the program and/or starting the in-patient ketamine treatment; this typically consists of a psychiatric evaluation and heart evaluation but can vary. If you know of one please send it to American RSDHope.
KETAMINE OUT-PATIENT IV BILLING CODES
Code Item
99213 Outpatient E&M Established Patient
96365 IV Infusion therapy/P
96366 IVInfusion therapy P
93041 Rhythm ECG 1-3 leads
J3490 Ketamine, IV
J2405 Ondansetron HCL Injection
J2765 Metoclopramide HCL Injecton
J2250 Injection Midazolam Hydroch
J7030 Infusion Normal Saline
36000 Intro Needle/Intracat
If anyone has any updated codes from these or any additional codes associated with these please send them to American RSDHope.
99223 Initial Hospital Services Level 3 H&P Day 1
99255 Level 5 Hospital Consult Day 1
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour Day 1
99295 Initial Inpatient, Intensive Care Unit, Room& Board, Incidentals Day 1
76499 Chest X-Ray Reading Day 2
99233 Level 3 Progress Note Day 2
99222 Level 3 Progress Note Day 3
99255 Level 5 Hospital Consult Day 3
99252 Level 2 Hospital Consult Day 4
99255 Level 5 Hospital Consult Day 4
99233 Level 3 Progress Note Day 5
99252 Level 2 Hospital Consult Day 5
(some physicians do the in-patient treatment for five days, some do seven and some vary the treatment depending on how the patient is responding to the treatment)
99233 Level 3 Progress Note Day 6
99255 Level 5 Hospital Consult Day 6
99255 Level 5 Hospital Consult Day 7
Lab Services Day 1-7
96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) Day 1-7
90774 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug Day 1-7
99295 Inpatient, Intensive Care Unit, Room& Board, Incidentals, Subsequent Care Day 1-7
J3490 Unclassified drug (use for Ketamine) Day 1-7
We do not know if there is a separate billing code for the pre-testing most physicians require prior to being accepted into the program and/or starting the in-patient ketamine treatment; this typically consists of a psychiatric evaluation and heart evaluation but can vary. If you know of one please send it to American RSDHope.
KETAMINE OUT-PATIENT IV BILLING CODES
Code Item
99213 Outpatient E&M Established Patient
96365 IV Infusion therapy/P
96366 IVInfusion therapy P
93041 Rhythm ECG 1-3 leads
J3490 Ketamine, IV
J2405 Ondansetron HCL Injection
J2765 Metoclopramide HCL Injecton
J2250 Injection Midazolam Hydroch
J7030 Infusion Normal Saline
36000 Intro Needle/Intracat
If anyone has any updated codes from these or any additional codes associated with these please send them to American RSDHope.
Notes on Ketamine Billing Codes
We wanted to add a few notes on the Ketamine IV Billing Codes.
1) Not all medical Clinics and/or Hospitals participate in insurance programs. They may require you to pay cash up-front and fight to get reimbursed by Medicare and/or your insurance company after the fact, after your treatment.
2) Not all insurance companies are participating in the reimbursement of these procedures, especially for the Out-Patient Ketamine IV procedures. If you google phrases such as "ketamine infusion for CRPS Billing Codes" or something along those lines you will see posts by various BC/BS companies and other insurance companies that state they do not believe there is enough factual proof yet that shows the out-patient ketamine especially has been shown to be successful in relieving patients pain for any significant amount of time so they will not reimburse patients for their out-of-pocket costs.
3) Medicare is currently paying for the in-patient IV Ketamine and in many cases other insurance companies are paying the co-pays for this procedure even if they do not pay for the out-patient version.
4) The best way to determine if you will be reimbursed is to talk with your companies coding/billing department ahead of time and make sure you use the codes above when referring to your procedure.
5) If anyone has dealt successfully with their insurance company and has any tips they would like to share and/or has any relevant newspaper or published articles they would like to share that we can publish here for others please send them to American RSDHope.
1) Not all medical Clinics and/or Hospitals participate in insurance programs. They may require you to pay cash up-front and fight to get reimbursed by Medicare and/or your insurance company after the fact, after your treatment.
2) Not all insurance companies are participating in the reimbursement of these procedures, especially for the Out-Patient Ketamine IV procedures. If you google phrases such as "ketamine infusion for CRPS Billing Codes" or something along those lines you will see posts by various BC/BS companies and other insurance companies that state they do not believe there is enough factual proof yet that shows the out-patient ketamine especially has been shown to be successful in relieving patients pain for any significant amount of time so they will not reimburse patients for their out-of-pocket costs.
3) Medicare is currently paying for the in-patient IV Ketamine and in many cases other insurance companies are paying the co-pays for this procedure even if they do not pay for the out-patient version.
4) The best way to determine if you will be reimbursed is to talk with your companies coding/billing department ahead of time and make sure you use the codes above when referring to your procedure.
5) If anyone has dealt successfully with their insurance company and has any tips they would like to share and/or has any relevant newspaper or published articles they would like to share that we can publish here for others please send them to American RSDHope.
