Pain Management Coding Alert

Published on Tue Dec 29, 2015 PDF

Question: It is possible to bill for non-chemo infusion 96365 and 96367 and hydration therapy 96360 on the same day? For instance, if we provide several medications, and between medications provide hydration for 30 minutes at a time for a total of 1.5 hours, can we also bill for the hydration by time?

Oklahoma Subscriber

Answer: No, you cannot bill infusion 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) and 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]) with hydration therapy 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour).

According to coding guidelines, you should report only one primary code to represent infusion, injection, and hydration. When fluids are used solely to administer drugs or other substances, the process is considered incidental hydration and should not be billed.

But: The CPT® section guidelines do qualify “Some chemotherapeutic agents and other therapeutic agents require pre- and/or post-hydration to be given in order to avoid specific toxicities. A minimum time of 31 minutes of hydration infusion is required to report the service. However, 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.”

Because of this, it may be possible to bill 96361 (Intravenous infusion, hydration; each additional hour [List separately in addition to code for primary procedure]), not 96360, along with the 96365 and 96367 codes. The infusion would need to be clearly for pre- or post-hydration instead of TKO purposes and be at least 31 minutes in length.