The 16-Minute Rule: CPT 96365 VS 96374

Alexis Wilkinson CPC
Feb 7
3 min read

A mere 60-second error can determine whether a service is billable. This is the critical "16-minute rule," which separates a simple push 96374 from a billable infusion 96365. The following logic translates complex MAR data in EPIC into precise, actionable codes to safeguard reimbursement.

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January 4: Emergency Department (ED) Services

On the initial date of service in the ED, the primary focus was on rapid symptom management.

96375 (IV Push, Each Additional): Toradol was administered via IV at 15:33. In an ED setting, because the initial service is often bundled into the facility fee or a primary infusion, this is reported as an additional sequential IV push.

January 5: Transition to Observation (OBV)

Observation services officially began at 06:39. The coding for this day reflects a mix of diagnostic contrast and pain management.

96375 x 2 (IV Push, Each Additional): Two distinct medications were delivered via IV push: Dilaudid at 03:20 and Gadavist (radiology contrast) at 21:21.
96372 (Injection, IM/SubQ): Lovenox was administered as a subcutaneous injection at 10:05. This code identifies injections delivered into the muscle or under the skin rather than the vein.

January 6: Coding IV Pushes Without Stop Times. Rule

This day highlights an important coding rule regarding documentation and the determination of service types.

96375 (IV Push, Each Additional):
- Ativan was administered as a standard IV push at 17:11.
- Vimpat (Lacosamide) was started at 19:02. Although administered via IVPB, the record is missing a "Stop Time". Per billing guidelines, without a recorded stop time to calculate duration, the service must be billed as an IV push.
96372 (Injection, IM/SubQ): Lovenox was again given subcutaneously at 10:07.

January 7: Calculating in Infusion Therapy CPT 96365

This was the most active day for administrations, requiring careful distinction between timed infusions and pushes based on the 16-minute rule.

96365 (Initial Infusion, up to 1 hour): Zovirax (Acyclovir) ran from 05:07 to 06:11. Because this lasted 64 minutes, it meets the requirement to bill the first "initial" hour.
96366 x 2 (Each Additional Hour): This code accounts for subsequent hours of the same drug. This includes the Zovirax bags running from 12:33–13:30 and 20:04–21:04.
96367 (Additional Sequential Infusion): Cerebyx was infused from 08:29 to 08:49. Since this is a different medication than the initial Zovirax, it is billed as a sequential service.
96375 x 2 (IV Push, Each Additional):
- Ativan at 04:53.
- Vancomycin at 05:10. This was stopped at 05:23. Because it lasted only 13 minutes—less than the 16-minute minimum required for an infusion—it is billed as an IV push.
96376 x 3 (IV Push, Same Drug): Decadron was administered three separate times: 03:55 , 11:27 , and 20:01. The 96376 code is used for subsequent pushes of the same substance.
96372 (Injection, IM/SubQ): Xylocaine (Lidocaine) was administered via injection at 15:00.

January 8: Maintaining the Initial Service

As a new calendar day begins, the first infusion resets the "Initial" code.

96365 (Initial Infusion, up to 1 hour): Zovirax ran from 03:19 to 04:20 , establishing the initial CPT 96365 infusion for the day.
96366 (Each Additional Hour): An additional hour was captured for the duration of the infusion therapy.
96376 x 2 (IV Push, Same Drug): Decadron was administered twice more, at 03:21 and 12:03.