Oncology & Hematology Coding Alert

Question: May I report a hydration code when a physician administers Phenergan and a 250-cc bag of common saline solution through an IV for a patient with diarrhea and vomiting? The infusion lasts 30 minutes.

Arizona Subscriber Answer: In this case, you should code only the drug infusion (90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour). Also report the medication (J2550, Injection, promethazine HCl, up to 50 mg) if you supplied the Phenergan.

Because the physician administers the drug through the same IV, coding both the hydration and the drug infusion would be double-dipping.

Rationale: You can identify hydration services using 90760 (Intravenous infusion, hydration; initial, up to 1 hour) and +90761 (- each additional hour [list separately in addition to code for primary procedure]), but CPT states that fluid used to administer the infusion of a drug is -incidental hydration- that you cannot report separately.

Example: The physician sees a patient with dehydration signs. During the encounter, the physician discusses IV fluid rehydration with the patient, establishes an IV and administers a normal saline (NS) solution bolus of 20 ml/kg, at which point the patient's condition stabilizes. The total hydration time is 50 minutes.

Solution: To report this infusion, you should use 90760 because it involves a hydration process.