# Hydration/Injections - I a patient is in the ER



## kissie (Mar 27, 2012)

I a patient is in the ER and gets hydration from 12: pm to 1 pm and also gets an IVP @ 12:16 of Zofran and an IVP of Phenagan @ 12:32 can you still the additional hour of infusion, 96374, 96375, and 96361?

Thank you


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## jdrwilliams (Mar 29, 2012)

*Hydration coding*

No the hydradtion code is for the first 31 mins to 1 hr of infusion. Try 96360, 96375 x 2


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## lwertman (Mar 29, 2012)

how would I code TKO IV started 30 min later phenegran IVP? would I only code the 96374?


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## monimrtin (Apr 3, 2012)

the TKO IV isn't codable. just code the 96374.


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## Mojo (Apr 5, 2012)

jdrwilliams said:


> No the hydradtion code is for the first 31 mins to 1 hr of infusion. Try 96360, 96375 x 2



In facility coding, the IVP is primary to hydration in the infusion/injection hierarchy and is the initial service in Kissie's scenario. I would code it as 96374, 96375, 96361 via one IV access.


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## mitchellde (Apr 5, 2012)

The only problem is you do not have 31 minutes of hydration alone.  You have from 12:32 to 1pm for the hydration which is just shy of the needed 31 minutes of continuous hydration.


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## ptrautner (Apr 5, 2012)

i think it is not clear enough to say how long was the push?  if you have thirty one minutes free and clear i say charge it otherwise its incidental hydration and unbillable...


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## Mojo (Apr 5, 2012)

When an IVP is administered while hydration is infusing, the hydration is not stopped (if there is KCL in the bag, the line is flushed before and after the med if incompatible) but NS is usually the fluid of choice in the ED. The tubing may be pinched briefly above the port where the IVP is connected, but clinically the hydration continues.

Our infusion calculator does not require a time entry for the IVP so there is no new "start" time to begin the hydration and the push times are not backed out of the hydration time. Is there any literature out there that addresses this gray area of the original poster's scenario?


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## Rita Bartholomew (Apr 6, 2012)

IVPs (96374 & 96375) are not time-based codes in their descriptors, even though an infusion of 15 mins or less is considered a push, so the times of the pushes are not deducted from the hydration time. Also, we talking about two separate dates of service.  So, code 96360 for the first date and 96374,96375 for the second date.


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## ccihon (Apr 6, 2012)

*Rn, cpc*

If it is an OBS, you code it as a single visit.  One initial only, no matter how many days they are in.  You need a full hour to code hydration after an injection, not 31 mintues, that is only for an initial code of hydration.  I have never heard of a push lasting 30 minutes.  Usually, in ER we only push a med for 5 minutes, otherwise we put a bag up and go for 30 minutes.  To me, the correct coding of the scenario is 96374 and 96375.  Now, if the patient has two lines established, then you can code two initials, if the physician orders mulpitle meds.


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## mitchellde (Apr 6, 2012)

ccihon said:


> If it is an OBS, you code it as a single visit.  One initial only, no matter how many days they are in.  You need a full hour to code hydration after an injection, not 31 mintues, that is only for an initial code of hydration.  I have never heard of a push lasting 30 minutes.  Usually, in ER we only push a med for 5 minutes, otherwise we put a bag up and go for 30 minutes.  To me, the correct coding of the scenario is 96374 and 96375.  Now, if the patient has two lines established, then you can code two initials, if the physician orders mulpitle meds.



You are correct, my bad on the 31 minutes. But i agree with your codes


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## Rita Bartholomew (Apr 9, 2012)

@ccihon -- does this still apply after the revision of 2012?  There is new guidance the CPT manual for injections/infusions when there is a crossover to another day.


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## Mojo (Apr 9, 2012)

Rita Bartholomew said:


> IVPs (96374 & 96375) are not time-based codes in their descriptors, even though an infusion of 15 mins or less is considered a push, so the times of the pushes are not deducted from the hydration time. Also, we talking about two separate dates of service.  So, code 96360 for the first date and 96374,96375 for the second date.



Rita, that is a good point that the IVPs are not time-based in their descriptors, but wasn't the OP regarding services on the same DOS?

For an ED visit involving one calendar day, how would you code Kissie's example?


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## Mojo (Apr 9, 2012)

ccihon said:


> If it is an OBS, you code it as a single visit.  One initial only, no matter how many days they are in.  You need a full hour to code hydration after an injection, not 31 mintues, that is only for an initial code of hydration.  I have never heard of a push lasting 30 minutes.  Usually, in ER we only push a med for 5 minutes, otherwise we put a bag up and go for 30 minutes.  To me, the correct coding of the scenario is 96374 and 96375.  Now, if the patient has two lines established, then you can code two initials, if the physician orders mulpitle meds.



It seems there are different interpretations of the use of 96361. My experience has been that only 31 minutes of continuous hydration is needed with another primary service. How are others interpreting 96361?

http://qhr.knowledgebase.co/article/use-of-code-96361.html


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## ccihon (Apr 10, 2012)

My interpretation stands.  96361 Intravenous infusion, hydration each additional "hour", (list separately in addition to code for primary procedure)  Under the National Coverage Provision...Subject # HONC-002.  http://www.wpsmedicare.com   96374, 96375


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## ccihon (Apr 10, 2012)

After further review, according to the coding clarification: facility reporting - multiple infusions   CPT Assistant Dec 2011 Volume 21 Issue 12, it states:

It makes a difference if you are coding a single calendar date or over a range of dates..it depends on how your facility interprets these definitions.  

Also, a minimum hydration infusion of 31 minutes is required to report pre and/or post hydration for some chemo agents, but I did not find where 31 minutes was mentioned for additional hydration codes (96361), I still feel it is one hour.

This is only how I interpret facility coding.  Looking at her original question, I would code 96374, 96375 and 96361, IF the hydration was medically necessary, if not, I would not code 96361.


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## alices (Apr 10, 2012)

*re-hydration/injections*

Hi if the hydration is from 12:00pm-1:00pm and IVP's were done we would code
96374 zofran, 96375 phenegran and 96361 for the hydration since it ran for 1 hour..thanks, alice


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## Rita Bartholomew (Apr 11, 2012)

New 2012 infusion revised coding guidelines in the CPT manual indicates that pushes at 11:00 p.m. and 2:00 a.m. would be coded as two initials (96374 x 2).  CMS, however, has not adopted these new guidelines.

AMA CPT Professional manual (pg xii) defines time units as follows: "A unit of time is attained when the mid-point is passed.  For example, an hour is attained when 31 minutes have elapsed (more than the midpoint between zero and sixty minutes)."  "A second hour is attained when a total of 91 minutes have elapsed."


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## Rita Bartholomew (Apr 11, 2012)

Mojo said:


> Rita, that is a good point that the IVPs are not time-based in their descriptors, but wasn't the OP regarding services on the same DOS?
> 
> For an ED visit involving one calendar day, how would you code Kissie's example?



It does appear that the OP's example occurs on one DOS.  I read it too quickly and interpreted the "12:00 p.m." as midnight instead of noon.  I would code this example as 96374, 96375, 96361.


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