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: If the oncologist gave the medications and hydration during the same encounter, then yes, the time hydration was administered and ran alone is billable.

First, code the initial therapeutic medication infusion indicated in the question with 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour).

Secondly, report is reported the second therapeutic medication administered 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]).

Lastly, since the total time of hydration was a total of 1 hour and 30 minutes, bill one unit of the add-on code +96361 (Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)). It is important to note, only one unit of 96360 is billed because the infusion of hydration would have had to be at least a total of 1 hour and 31 minutes to report two units.

CPT^® code 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour), as suggested in the question, would be incorrect because according to coding guidelines, you may only report one primary code to represent the primary reason for the regimen given and per encounter. Since in this case, we are assuming the therapeutic medication was the primary reason for the encounter and hydration was secondary, 96365 would be the primary code reported, so 96360 would be incorrect.

Watch out: We are also assuming the hydration was administered alone and not with another medication running at the same time, nor was the fluids given used solely to administer drugs or other substances. In either of these cases, hydration would not be billable. When fluid is given to deliver other medications, the process is considered incidental hydration and should not be billed.

Also, keep in mind, hydration, like medication orders, should indicate the purpose for hydration. It may be given for volume depletion or perhaps prophylactically to prevent nausea or other harmful effects of the medication regimen.