Oncology & Hematology Coding Alert

Question: Recently, one of our patients received hydration for 45 minutes. At that point, the nurse stopped the hydration and administered Rocephin for 30 minutes, then restarted the hydration and administered it for another hour.

In this situation, can we bill for the hydration?

AAPC Forum Participant

Answer: The issue in this scenario, and others like it, is whether the purpose of the hydration is for keeping the intravenous (IV) line open so the patient can receive the drug, or whether there is medical necessity or therapeutic purpose for the hydration.

If the purpose of the hydration is simply to keep the IV line flowing so a provider can administer a drug, then you cannot separately bill for the hydration service. But if the hydration is considered a part of the treatment regimen — for example, the drug has a toxic side effect that is reduced when the patient is hydrated, or the hydration aids in rehydrating a patient suffering from vomiting or diarrhea — then a payer may reimburse the administration of hydration.

Medicare explains it this way: “When the sole purpose of the IV fluid administration is to establish and/or maintain vascular access or patency of the IV line, the service is neither diagnostic nor therapeutic and must not be separately reported.” However, when your provider administers IV fluids, and you can provide documentation for the medical necessity that the fluids are aiding symptoms of dehydration or fluid loss, then you can report the service separately (see www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Approved-RAC-Topics-Items/0137-IV-Hydration-Administration).