Challenge 3 common areas of confusion.
Questions about accurate hydration coding are by no means rare, whether you're trying to comprehend the basics or need to look into the confusing world of hydration with chemotherapy infusions. Here are the answers to three top hydration medical billing and coding questions .
1. How Does the 31-Minute Rule Apply?
Question: In case we use the initial hydration code for the first half-hour, how do you use the subsequent code? Is it applicable for every half-hour or every hour? What are the existing rules on rounding the time?
Answer: CPT® guidelines instruct you that you must not report 30 minutes or less of hydration distinctly. CPT code 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) is correct for the initial 31 to 60 minutes of hydration time, as per the definition. Consequently, 96360 will be sufficient for up to 90 minutes of hydration.
Here's why: For CPT code 96360, documentation should indicate more than 30 minutes (that is, 31 minutes or more) of hydration therapy. Likewise, for +96361 (… each additional hour [List separately in addition to code for primary procedure]) documentation should indicate more than 30 minutes of hydration therapy beyond a one-hour increment of the initial service. Thus in case 96360 is the initial service, +96361 is not correct until the patient has had at least 91 minutes of hydration (60 minutes plus 31 minutes).
2. How Do You Code Hydration Following an IV Push?
Question: Staff administered chemotherapy through intravenous (IV) push. Then, staff administered 95 minutes of hydration. How should you report the administration codes for this encounter?
Answer: In case the patient received chemotherapy via IV push and subsequently received 95 minutes of hydration, you would use CPT code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) for the IV push of chemotherapy and +96361 x 2 for the hydration, as supported by the documentation.
Notice that the accurate hydration coding involves +96361 (each additional hour) and not 96360 (initial).
Here's why: You must report CPT codes 96360 only when the hydration is the "initial" service. (Remember this CPT® guideline: "When administering multiple infusions, injections or combinations, only one ‘initial' service code should be reported for a given date, unless protocol requires that two separate IV sites must be used.") Physician coders must select the initial code based on the primary reason for the patient visit (such as chemotherapy). Facility coders, on the other hand, follow a hierarchy outlined in CPT® guidelines.
Questions about accurate hydration coding are by no means rare, whether you're trying to comprehend the basics or need to look into the confusing world of hydration with chemotherapy infusions. Here are the answers to three top hydration medical billing and coding questions .
1. How Does the 31-Minute Rule Apply?
Question: In case we use the initial hydration code for the first half-hour, how do you use the subsequent code? Is it applicable for every half-hour or every hour? What are the existing rules on rounding the time?
Answer: CPT® guidelines instruct you that you must not report 30 minutes or less of hydration distinctly. CPT code 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) is correct for the initial 31 to 60 minutes of hydration time, as per the definition. Consequently, 96360 will be sufficient for up to 90 minutes of hydration.
Here's why: For CPT code 96360, documentation should indicate more than 30 minutes (that is, 31 minutes or more) of hydration therapy. Likewise, for +96361 (… each additional hour [List separately in addition to code for primary procedure]) documentation should indicate more than 30 minutes of hydration therapy beyond a one-hour increment of the initial service. Thus in case 96360 is the initial service, +96361 is not correct until the patient has had at least 91 minutes of hydration (60 minutes plus 31 minutes).
2. How Do You Code Hydration Following an IV Push?
Question: Staff administered chemotherapy through intravenous (IV) push. Then, staff administered 95 minutes of hydration. How should you report the administration codes for this encounter?
Answer: In case the patient received chemotherapy via IV push and subsequently received 95 minutes of hydration, you would use CPT code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) for the IV push of chemotherapy and +96361 x 2 for the hydration, as supported by the documentation.
Notice that the accurate hydration coding involves +96361 (each additional hour) and not 96360 (initial).
Here's why: You must report CPT codes 96360 only when the hydration is the "initial" service. (Remember this CPT® guideline: "When administering multiple infusions, injections or combinations, only one ‘initial' service code should be reported for a given date, unless protocol requires that two separate IV sites must be used.") Physician coders must select the initial code based on the primary reason for the patient visit (such as chemotherapy). Facility coders, on the other hand, follow a hierarchy outlined in CPT® guidelines.
