How Do I Report Hydration and Reclast® Infusion?

Q: What is the proper CPT® coding for Reclast® infusion? Reclast® requires a 30-minute hydration prior to administration. May we report this separately?
A: Reclast® (zoledronic acid) is an infused medication used to treat osteoporosis and Paget’s disease of bone. The appropriate HCPCS Level II supply code for Reclast® is J3489 Injection, zoledronic acid, 1 mg.
For an initial infusion of Reclast® lasting 16 minutes or longer, report 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour. An initial infusion lasting 15 or fewer minutes is considered an IV push, reported with 96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug. Novartis, which manufactures Reclast, states that the drug “must be administered as an intravenous infusion over no less than 15 minutes” [emphasis added].
Billing for hydration in combination with other infusions is a common source of confusion. Hydration of 30 minutes or less is never separately billable. Nor may you separately report hydration if it’s performed concurrently with administration of a drug.
American Medical Association (AMA) guidelines, outlined in CPT® Assistant (December 2011), allow separate reporting of hydration in specific circumstances:
Some chemotherapeutic and other therapeutic agents require pre- and/or posthydration to be given to avoid specific toxicities. In these circumstances, if hydration services are provided before or after the intravenous chemotherapeutic or other therapeutic agent administration, it is both clinically necessary and appropriate to additionally report the hydration infusion services.
The CPT® codebook includes similar instruction.
Per Novartis, “Patients must be appropriately hydrated prior to administration of Reclast.” As such, separate billing for hydration prior to Reclast® infusion is medically reasonable and necessary (this should be reiterated in the medical documentation). Assuming at least 30 minutes of hydration is performed and documented, the service is reported using 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour and +96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure). For most payers, you’ll need to append modifier 59 Distinct procedural service to the hydration code(s) to indicate that it is separate from the infusion (e.g., 96365).
All infusion (and hydration) times should be documented. Ideally, the administering provider will note the volume, start and stop times, and infusion rate(s).
Resource
Novartis: www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/reclast.pdf

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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