Follow This Advice for Accurate IV Hydration Billing
Question: A patient received intravenous (IV) hydration from 1050-1325 and chemotherapy from 1120-1305. That means that there was a 29-minute span prior to chemo and a 20-minute span after chemo that was not concurrent. The combined time of the nonconcurrent hydration was 49 minutes, which we believed met the requirement for billing 96361, but the payer denied. The payer stated, “While the IV fluids ran continuously during the medication infusion, the intravenous fluids are not considered hydration when concurrent with a medication infusion; this interrupts the continuous infusion of intravenous fluids. Consequently, the hydration before and after the medication infusion cannot be combined to satisfy the 31-minute time requirement.” Is the payer correct? AAPC Forum Participant Answer: In this instance, the payer’s rationale to deny payment for 96361 (Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)) is correct. A CPT® Assistant article (June 2007: Volume 27, Issue 6) explains why. The article specifically states that “Hydration of sufficient time to meet coding requirements, when a necessary part of therapy and when performed either before or after chemotherapy, is separately reportable using the each additional hour code.” The article also states “Hydration codes may not be concurrent but may be sequential.” That would suggest you were correct in billing separately for the hydration administered before and after chemotherapy. However, the article goes on to note that “if the IV fluid continues to run while the chemotherapeutic agent is infusing… [pre- and post-hydration] are not separately reportable and this time is not added to the total hydration infusion time.” This would also be true if the IV fluid was infused at the same time as the chemotherapy drug, or if the IV fluid is necessary to safely infuse a drug such as Adriamycin (doxorubicin) or vincristine that can cause severe tissue damage or necrosis if it leaks from the vein in which it is being administered. Regardless of the reason the provider administered IV hydration to the patient, the fact that it was administered before, during, and after chemotherapy administration precludes billing for 96361. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
