Oncology & Hematology Coding Alert

Question:  When billing for infusions when the same drug is being infused multiple times using 96365 and 96367, we look at each individual infusion and report the additional hours infusion code (96366). Do we do the same with hydration? For example, on DOS 10/22/2021, the patient received 54 minutes of hydration, then an hour later, a second hydration for 35 minutes through same IV line: Would we add the times together and bill only 96360 (because it was only 89 min) OR would each hydration time be separate and we would bill 96360, 96361?

Maine Subscriber

Answer: In order to bill 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) and +96361 (… each additional hour (List separately in addition to code for primary procedure)), you must make sure you follow CPT^® guidelines, not only for time but also for the purpose of the infusion.

In the scenario you describe, you do not say whether the purpose of the infusion is solely for hydration. In this regard, CPT^® guidelines tell you “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.”

You also did not indicate whether the hydration “an hour later” was the same encounter, or a separate encounter after the infusion for the therapeutics was finished and the patient encounter ended.

So, assuming the hydration “an hour later” is the only service your patient received in the separate encounter, you can use 96360 for the additional 35 minutes for the second encounter. Here, CPT^® guidelines tell you “a minimum time of 31 minutes of hydration infusion is required to report the service.” And in the second encounter, all that was provided was hydration of 35 minutes. The second encounter 96360 would require a modifier 59 indicating the hydration infused “an hour later” was a separate encounter scenario.

If, however, the hydration “an hour later” was at the same encounter after other drugs were infused, you would only use the +96361 (1 unit) to report all the hydration time added together, 89 minutes. This is because the CPT^® requirement of meeting a minimum of 31 minutes allows for the use of 96361 and to use a second unit of +96361 you would have needed to infuse the hydration at least 91 minutes to bill for 2 units of the code.

Consider the initial reason for the encounter(s). If all infusions were given during one encounter, the medication infusion would typically become the initial service, and you would not report 96360. Instead, you would report your initial therapeutic 96365, other drugs with 96367 and additional hours exceeding 30 minutes beyond the initial hour with +96366, then the +96361 for hydration as ordered as it exceeded the 31 minutes of time and did not meet the 91 minutes for reporting more than 1 unit.