# 52 Modifier for 96360 IV Hydration?



## coding303 (Apr 23, 2014)

I have always led to believe that hydration performed for less than 31 minutes is not a billable service.  I am currently employed with a provider who believes that it can be billed regardless of time.  My question for whomever may be able to help me is if 96360 can be billed with a 52 modifier if performed for under 31 minutes or when the IV start time is documented but the documentation lacks an end time.

Any assistance would be appreciated.


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## OCD_coder (Apr 23, 2014)

Here is the Medicare rules regarding Hydration running less than 30 minutes.  As an FYI the only modifier's allowed for the 96360 initial code is 59 and PD.

*Hydration Therapy*

Hydration must be medically reasonable and necessary. If documentation supports a clinical condition that warrants hydration, other than one brought about by the requirements of a procedure, the hydration may be separately billable. 

When fluids are used solely to administer the drugs, i.e. the fluid is merely the vehicle for the drug administration, the administration of the fluid is considered incidental hydration and not separately billable. 

CPT instructions require the administration of a hydration infusion of more than 30 minutes in order to allow the coding of hydration as an initial service. Hydration of less than 30 minutes is not separately billable. *The charges for an administration of 30 minutes or less should be reported with an appropriate revenue code but without a HCPCS or CPT code.* Hydration therapy of 30 minutes or more should be coded as initial, 31 minutes to one hour and each additional hour should be listed separately in addition to the code for the primary infusion/injection.

References: 

CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, ??10.4 and 230.

*When can hydration be billed?*

Documentation must indicate that the hydration service is medically reasonable and necessary. It should not be an integral part of another service such as an operative procedure. The rate of infusion should be included in the documentation. When fluids are used solely to administer drugs or other substances, the process is considered incidental hydration and should not be billed. To code hydration as an initial service, hydration must be a medical necessity and administered for more than 30 minutes. Hydration of 30 minutes or less is not separately billable. The charges for an administration of 30 minutes or less should be reported with an appropriate revenue code but without a HCPCS or CPT code. Each additional hour of hydration infusion requires an initial service being delivered (hydration or other infusion/injection service). 

*If a patient is receiving an IV infusion for hydration and the stop time is not documented in the medical record, how should the service be coded?*

Infusion times should be documented. Hydration of 30 minutes or less is not separately billable. When requested, providers should submit documentation indicating the volume, start and stop times, and infusion rate (s) of the solution provided. In the absence of the stop time the provider should be able to calculate the infusion stop time with the volume, start time, and infusion rate and code accordingly.

Source link:
https://www.cgsmedicare.com/parta/pubs/news/2011/0211/011.html


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## coding303 (Apr 24, 2014)

Thank you OCD_Coder!

That is what I thought and knew but and I needed a little backup and you are my hero!  Now I feel more confident in my response given to my employer regarding this issue.  Thank you again


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