Oncology & Hematology Coding Alert

If you’re thinking intravenous (IV) hydration coding is just a matter of reporting 96360-96361, think again. There is much to consider for hydration. You must know (1) when to bill an E/M visit and (2) how to steer your way through hospital admission coding if you want to receive optimal reimbursement for patients who received hydration.

Your oncologist may be using hydration as a part of treatment regimen. You may come across varying durations for hydration. 

For the first hour, use 90360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour). Bill additional hours with add-on code +96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]). 

Vital: Remember any additional hour can be billed only if the minutes of time past the full hour increment exceed 30 minutes. 

Also remember that this add-on code (96361) is reported in addition to the primary procedure and cannot be reported as a stand-alone code. The primary hydration code is 96360, but CPT® codes 96365, 96374, 96409 or 96413 may also play the role of the primary CPT® code on the claim. 

Remember to report your J codes for the supply(ies), such as, but not limited to, J7030 (Infusion, normal saline solution, 1000 cc), J7050 (…250 cc) or J7042 (5% dextrose/normal saline [500 ml = 1 unit]), depending on the fluid and amount.

Soak Up Reimbursement with E/M Codes

When the physician assesses the patient and determines the need for hydration and documentation supports medical necessity of the assessment on the day of hydration, an E/M visit may also be warranted. For example, if the patient needs to be administered a chemotherapeutic agent that is largely eliminated through kidneys; your physician may assess the patient’s hydration status. This is because your physician is trying to ensure the drug will be effectively cleared from the body.

You can bill for an E/M as well if your physician does it as a separately identifiable service. You will need to check with your payer in this regard. 

Documentation is crucial: Write a good E/M note and make sure it is in a separate paragraph from the note about the hydration. The need for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) also varies from carrier to carrier.

Prolonged Services Codes Will Parch You

Some coders mistakenly use prolonged services codes 99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management service]) – 99355 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes [List separately in addition to code for prolonged service])  with 96361. This is incorrect coding because both the IV hydration codes and the prolonged services codes are by definition time-based, so the two cannot be combined over the same course of time. Nor should you use the prolonged service codes instead of 96360-96361, unless the physician remains with the patient for the entire treatment. For 90630 and 90631, the physician must directly supervise the case but not necessarily be face-to-face with the patient. Prolonged services codes require face-to-face contact. Many private payers don’t recognize prolonged services, and most patients requiring constant face-to-face contact would be transferred to the hospital.

Not Wet Yet: Billing the Hospital Admit

Sometimes, even after office hydration, the physician may admit the patient to the hospital. In this scenario you can still bill for the in-office hydration. The physician time and supplies for the hydration are paid separately. Bill the hospital initial care code (99221-99223), not the outpatient E/M service. Include the work you did in the office when selecting the level of admission code. As long as you include your notes for the office hydration and evaluation, be considered when leveling the hospital admission E/M CPT® code.

Whether the patient is subsequently admitted or not has no bearing on whether you can bill the hydration administration performed in the office. Billable services are billable whether you admit the patient or not.