Know When to Bill for Hydration Services
Question: If a patient received hydration for 45 minutes, then a chemotherapy infusion for 30 minutes and then the hydration is continued for another hour, can we bill for the hydration? Florida Subscriber Answer: Billing for hydration services using 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) or +96361 (... each additional hour [List separately in addition to code for primary procedure]) depends entirely on context. If the purpose of the hydration is for keeping the intravenous (IV) line open so the patient can receive the drug, then the answer, at least as far as Medicare is concerned, is no. If, however, the hydration is medically necessary and is being administered for therapeutic purposes, then you can make a case to be reimbursed for the service. The Medicare Coverage Database article “Billing and Coding: Hydration Services” outlines various scenarios and their eligibility for payment. Payable scenarios: The patient exhibits “symptoms warranting hydration, such as those associated with dehydration, the inability to ingest fluids or clear clinical contraindication to oral intake, abnormal fluid losses, abnormal vital signs, and/or abnormal laboratory studies, such as an elevated BUN [blood urea nitrogen] creatinine, glucose or lactic acid.” This may not include nausea, as that symptom “does not necessarily indicate fluid volume depletion nor support necessity of fluid repletion,” according to the article. Additionally, hydration may be appropriate for “prevention of nephrotoxicity immediately before or after transfusion, chemotherapy, or administration of potentially nephrotoxic medications.” Non-payable scenarios: These include such circumstances as using hydration to keep an IV line open before, during, and after chemotherapy, a therapeutic infusion or transfusion; using hydration to maintain normal fluid levels; using hydration at the same time as the drug being administered intravenously; and using hydration to dilute the drug’s concentration. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
