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!
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!