Billing and Coding: Hydration Services

Noridian Medical Review (MR) has observed errors in billing for intravenous (IV) hydration services. This article is to assist in better understanding the proper usage of the below codes for billing and coding purposes. CPT Definition: 96360: Intravenous Infusion, hydration; initial, 31 minutes to 1 hour 96361: Intravenous Infusion, hydration; each additional hour (list separately in addition to code for primary procedure) These codes are intended to report a hydration IV infusion consisting of pre-packaged fluid with or without electrolytes (e.g. normal saline, D5-1/2 normal saline+30mEq KCl/liter) and are not used to report infusion of drugs or other substances. Hydration Defined: The hydration codes 96360 and 96361 were developed to report specific therapeutic interventions undertaken when a patient presents with dehydration and volume loss requiring clinically necessary intravenous fluid. The necessity for hydration should be supported in the medical record. Documentation would include but is not limited to: A. Clinical assessment, typically on the same date of service, of the patient’s anticipated fluid needs. This can be demonstrated from the patient’s history, clinical examination, and pertinent laboratory testing to support the need for IV hydration therapy as reasonable and necessary for the patient’s treatment or diagnosis. Documentation of the assessment should describe symptoms warranting hydration, such as those associated with dehydration, the inability to ingest fluids or clear clinical contraindication to oral intake, abnormal fluid losses, abnormal vital signs, and/or abnormal laboratory studies, such as an elevated BUN, creatinine, glucose or lactic acid. Nausea itself does not necessarily indicate fluid volume depletion nor support necessity of fluid repletion. B. These codes are not intended to be reported/billed by the physician or other qualified healthcare professional in the facility setting, as these codes most likely represent facility charges with applicable reimbursement through the respective fee schedule. However, in the physician office setting (example, Place of Service 11), the physician may report these codes when the physician’s clinical staff or the physician administers the fluids. C. For facility reporting, an initial infusion is predicated on using a hierarchy. D. When administering multiple infusions (e.g. IV fluids and subsequent IV chemotherapy infusion on same date of service), only one primary infusion code should be reported for a given date, unless protocol requires that two separate IV sites must be used. E. Hydration cannot be reported concurrently with any other infusion or drug administration service. F. The definition of infusion time is inherent and presented in the guidelines for these codes. In other words, a minimum time duration of 31 minutes of hydration infusion is required to report the service. G. Consequently, infusion time is calculated from the time the administration commences (i.e. the infusion starts dripping) to when it ends (i.e. the infusion stops dripping). H. In accordance with Medicare Reasonable and Necessary Criteria, (Medicare Program Integrity Manual, Chapter 3, Section 3.6.2.2), the benefit must meet but does not exceed the beneficiary’s medical need, and as such, IV fluids should be avoided if not deemed clinically necessary. For example, although some conditions may warrant intravenous rehydration, if documentation supports the same benefit could be achieved by oral hydration, IV hydration would not be considered reasonable and necessary. However, it is understood that there are clinical scenarios in which the patient's need for hydration cannot wait for oral trials, even if an option. The intent should be understood within the body of documentation. I. Examples of Additional Payable Scenarios: If therapeutic fluid administration is medically necessary: for the correction of dehydration or prevention of nephrotoxicity immediately before or after transfusion, chemotherapy, or administration of potentially nephrotoxic medicati