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Oncology & Hematology Coding Alert

Infusions:

96360, +96361: Hydration in Focus for Oncology/Hematology Practices

Published on Mon May 14, 2012

Tackle 3 common areas of confusion.

Questions about proper hydration coding are by no means rare, whether you're trying to understand the basics or need to delve into the confusing world of hydration with chemotherapy infusions. Here are the answers to three top hydration coding questions.

1. How Does the 31-Minute Rule Apply?

Question: If we use the initial hydration code for the first half-hour, how do we use the subsequent code? Is it for every half-hour or every hour? What are the rules on rounding the time?

Answer: CPT® guidelines instruct you not to report 30 minutes or less of hydration separately. Code 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) is appropriate for the initial 31 to 60 minutes of hydration time, according to the definition. As a result, 96360 will suffice for up to 90 minutes of hydration.

Here's why: For 96360, documentation must indicate more than 30 minutes (that is, 31 minutes or more) of hydration therapy. Similarly, for +96361 (... each additional hour [List separately in addition to code for primary procedure]) documentation must indicate more than 30 minutes of hydration therapy beyond a one-hour increment of the initial service. So if 96360 is the initial service, +96361 is not appropriate until the patient has had a minimum of 91 minutes of hydration (60 minutes plus 31 minutes).

Consider this table, indicating proper coding when a patient presents solely for hydration therapy:

For those cases where hydration is not the only infusion service, see the next two questions.

2. How Do You Code Hydration Following an IV Push?

Question: Staff administered chemotherapy via intravenous (IV) push. After that, staff administered 95 minutes of hydration. How should we report the administration codes for this encounter?

Answer: If the patient received chemotherapy via IV push and subsequently received 95 minutes of hydration, you would 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, says Kelly Loya, CPC-I, CHC, CPhT, manager for Sinaiko Healthcare Consulting Inc., a reimbursement services division of Altegra Health.

Notice that the correct hydration coding involves +96361 (each additional hour) and not 96360 (initial).

Here's why: You should report 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 should choose the initial code based on the primary reason for the patient visit (such as chemotherapy). Facility coders, in contrast, follow a hierarchy outlined in CPT® guidelines.

Consequently, if the patient has a chemotherapy IV infusion at the same session as the hydration, the documentation most likely will support reporting the chemotherapy as the initial infusion. If documentation and orders support reporting medically necessary hydration as well, you should report +96361 x2 for the 95 minutes total hydration time rather than using 96360 first, and then +96361 for the remaining time past 91 minutes, says Loya.

3. How Do You Code Hydration During Drug Admin?

Question: Can infusion of Venofer be billed with saline in an office setting providing the start and end times are documented? Or is the saline considered inclusive and not billed separately?

Answer: In this case, you should report the Venofer administration (96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) and the Venofer supply (J1756, Injection, iron sucrose, 1 mg). You should not separately report the hydration (+96361) or saline supply (such as J7050, Infusion, normal saline solution, 250 cc).

Reason: "The trick to coding hydration is to look for whether any drug has been administered" during the same time the hydration solution is running, says Michelle Worcester, CPC, CEDC, CEMC, with Centura Health in Denver, Colo.

"Remember for infusion that if the 'hydration' is done specifically to deliver the drug, then it is inappropriate to code for hydration, even if you have time documented. You do not have medical necessity" for hydration therapy, says Worcester.

Support: Medicare's Correct Coding Initiative (CCI) policy manual states, "Hydration concurrent with other drug administration services is not separately reportable" (Chapter 11, Section B.5).

On the other hand, "If therapeutic fluid administration is medically necessary (e.g., correction of dehydration, prevention of nephrotoxicity) before or after transfusion or chemotherapy, it may be reported separately" (Section B.4, emphasis added). You may download the manual at www.cms.gov/NationalCorrectCodInitEd/.

The CMS rule is in line with CPT® infusion guidelines:

  • "Hydration may not be reported concurrently with any other service"
  • "The fluid used to administer the drug(s) is considered incidental hydration and is not separately reportable" (emphasis added).

Bottom line: You need to be cautious when deciding whether to report hydration performed at the same session as drug administration. To avoid confusion and promote documentation quality, ask physicians to document clinical rationale when they intend to include hydration as part of the medication therapy order, says Loya.

Learn more: In addition to reviewing CPT® guidelines, you should watch for payer instruction. For instance, Medicare discusses "Payment for Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions" in Medicare Claims Processing Manual, Chapter 12, Section 30.5 (www.cms.gov/manuals/downloads/clm104c12.pdf).

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