Oncology & Hematology Coding Alert

Question: It is possible to bill for non-chemo infusion 96365 and 96367 and hydration therapy 96360 on the same day? For instance, if our provider administers several medications, and between medications provides hydration for 30 minutes at a time for a total of 1.5 hours. In this case, can we also bill for the hydration by time?

Oklahoma Subscriber

Answer: No, you cannot bill the hydration. If all three (3) were given for 30 minutes each, the initial infusion 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) is reported with the add-on code +96367 (… additional sequential infusion of a new drug/substance, up to 1 hour [List separately in addition to code for primary procedure]) only. 

According to coding guidelines, report only one primary code to represent the primary reason for the regimen given during the encounter. In this case, as no medication names were given and only the therapeutic CPT^® administration codes 96365 and 96367, we are assuming both medications were therapeutic (diagnostic or prophylactic). When fluids are used solely to administer drugs or other substances, the process is considered incidental hydration and should not be billed. Additionally, the hydration ran for less than the 31 minutes required to report hydration, so it would not be reported. If the hydration had run at least 31 minutes, it was ordered by the physician and the purpose of hydration noted, it would have been reportable.

However: The CPT^® section guidelines do qualify “Some chemotherapeutic agents and other therapeutic agents require pre- and/or post-hydration to be given in order to avoid specific toxicities. A minimum time of 31 minutes of hydration infusion is required to report the service. However, the hydration codes 96360 or 96361 are not used when the purpose of the intravenous fluid is “to keep open” an IV line prior to or subsequent to a therapeutic infusion, or as a free-flowing IV during chemotherapy or other therapeutic infusion.”

For hydration, when appropriately ordered and documented, when the only infusion service provided in the encounter and given for at least for 31 minutes, it would be possible to bill 96360 (Intravenous infusion, hydration, initial 31 minutes to 1 hour) and the 96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]) for time intervals greater than 30 minutes of each additional hour beyond the initial hour increment.  If any medication is infused during the encounter it would typically become the initial service and only 96361 would be reported for hydration as ordered and exceeding 31 minutes of time.