Oncology & Hematology Coding Alert

Question: We are billing Medicare for a chemotherapy infusion. The patient received an infusion of leucovorin mixed with 1000 cc of D5W. My question is this: Is the D5W billable? Is it appropriate to bill J0640 with J7070?

AAPC Forum Participant

Answer: Under Medicare rules, you may not bill for hydration when “the fluid [is] used to administer the drug(s). Medicare regards this as “incidental hydration and is not separately payable” (Medicare Claims Processing Manual, Chapter 12, 30.5.C).

In other words, “When fluids are used solely to administer the drugs, i.e. the fluid is merely the vehicle for the drug administration, the administration of the fluid is considered incidental hydration and not separately billable,” according to the Medicare Coverage Database article “Billing and Coding: Infusion, Injection and Hydration Services.”

So, Medicare considers the hydration included with the infusion service that accompanies J0640 (Injection, leucovorin calcium, per 50 mg), and you cannot report J7070 (Infusion, D5W, 1000 cc) separately in this case.

However, the Medicare Coverage Database article goes on to note, “If documentation supports a clinical condition that warrants hydration, other than one brought about by the requirements of a procedure, the hydration may be separately billable.” The hydration service would have to last at least 31 minutes, excluding any time when running concurrently with drug infusions, in order to be reported.