Wiki Billing hydration services J7030, J7040?

[emonet01]

Good afternoon,

Recently we started receiving denials from Aetna (no other payers at this time) stating that when we are billing hydration services 96360, 96361 we are not allowed to bill the saline solution J7030, J7040 as they are bundled with the procedure. We have not had issues with this in the past or with other payers. Has anyone else been experiencing this?

In reviewing the 96360, I do see in the coding guidelines:

"Basic intravenous fluids such as prepackaged fluid and electrolytes (e.g., normal saline, D5-1/2 normal saline+30mEq KCl/liter) are included in these codes, as well as their administration. Do not report hydration codes when a substance or drug is added to a bag of fluid. When a drug is added to the fluid, the fluid is then considered to be a part of the other infusion."

My interpretation of that is that we should not be billing the J7030 or the J7040 with the admin codes. Am I interpreting this correct? If so, would there ever be an appropriate time to bill the saline HCPCS codes? Just wanted some advice from fellow coders before ruffling feathers within the reimbursement department.

Thank you for your feedback!

 

[thomas7331]

Good afternoon,

Recently we started receiving denials from Aetna (no other payers at this time) stating that when we are billing hydration services 96360, 96361 we are not allowed to bill the saline solution J7030, J7040 as they are bundled with the procedure. We have not had issues with this in the past or with other payers. Has anyone else been experiencing this?

In reviewing the 96360, I do see in the coding guidelines:

"Basic intravenous fluids such as prepackaged fluid and electrolytes (e.g., normal saline, D5-1/2 normal saline+30mEq KCl/liter) are included in these codes, as well as their administration. Do not report hydration codes when a substance or drug is added to a bag of fluid. When a drug is added to the fluid, the fluid is then considered to be a part of the other infusion."

My interpretation of that is that we should not be billing the J7030 or the J7040 with the admin codes. Am I interpreting this correct? If so, would there ever be an appropriate time to bill the saline HCPCS codes? Just wanted some advice from fellow coders before ruffling feathers within the reimbursement department.

Thank you for your feedback!

The coding guideline you've cited here is instructing that you should not report the hydration codes (96360-96361) when a drug or therapeutic substance has been added to the bag of fluid - that's because in those situations you are billing for the therapeutic administration instead, and the hydration administration is incidental. It does not mean that you should not bill for the saline or drugs themselves. In my experience, it's always been appropriate to charge separately for those.

What you're dealing with here, though, is not a coding issue but a reimbursement policy. Payers set rates for services and determine what items they are going to include in those rates. So your Aetna plan may (and should) have a policy that states that they have already incorporated the costs of the saline solution into the rates that they've set for their hydration codes. If you're contracted with that plan, then you're required to accept those rates and the charges for the saline will need to be written off. But it doesn't mean that you shouldn't code or charge for them, because other payers may not have this same policy.