Wiki Chemotherapy services

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LindaEV

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I'm trying to learn billing for Chemo, and other injection/infusion services.

From what I understand, hydration, when administered with the chemo, is not seperately payable. However you can bill it if it is administered seperately, as a subsequent service...for example if the patient becomes dehydrated because of the chemo.

Is this correct?

Does anyone have any resources on this?

This is for an outpatient setting.

Thanks.
 
I am a hem/onc coder and I code the Chemo and IV drug infusion for our group. Yes, Hydration when administered concurrently (with) chemo or an IV drug can not be seperately billed. Per CPT coding guidelines, Hydration, when administered at the same encounter as chemotherapy or other IV drugs must run 31 minutes or more independently of the IV infusion to be eligible for seperate billing, and would be reported using add on code 96361 (your initial service code would be your chemotherapy administration or other IV drug infusion administration).

Hydration service code 96360 (intravenous infusion, hydration ;intial, 31 min to 1 hour) is an INITIAL service code and Can only be billed if it is just that the initial service, and the hydration is running at least 31 minutes up to one hour, each additional hour would be reported w/ 96361.

The guidelines for reporting these services are in your CPT code book
also you can find information on your local Medicare web site, and CMS Claims processing manual chapter 12

Best Wishes!
 
chemotherapy

Some chemotherapy infusions require hydration pre and post chemo administration and CPT addresses this. You can code for the pre and post but any hydration given during the course of the administration of the chemo is not codable. Check your carrier and Medicare guidelines.
 
Hello my name is Liza and I as well bill for chemo infusions. MrsClark75 is exactly correct. Medicare may allow you to bill for the actual solution and will reimburse for that you just cannot bill for the administration of it when it is administer concurrently with the chemo. As MrsClark stated it has to run for 31 mins or more and to my understanding it has to be done an hour before or after chemo.

Thanks much,
Liza
 
LINDALOUH said:
I'm trying to learn billing for Chemo, and other injection/infusion services.

From what I understand, hydration, when administered with the chemo, is not seperately payable. However you can bill it if it is administered seperately, as a subsequent service...for example if the patient becomes dehydrated because of the chemo.

Is this correct?

Does anyone have any resources on this?

This is for an outpatient setting.

Thanks.
Click to expand...

You are correct. You can bill for they hydration even during the pre meds but once the chemo starts, the hydration time stops. If the patient continues the hydration after the chemo, you can start billing this time as well. Hope this helps.
 
mrsclark75 said:
I am a hem/onc coder and I code the Chemo and IV drug infusion for our group. Yes, Hydration when administered concurrently (with) chemo or an IV drug can not be seperately billed. Per CPT coding guidelines, Hydration, when administered at the same encounter as chemotherapy or other IV drugs must run 31 minutes or more independently of the IV infusion to be eligible for seperate billing, and would be reported using add on code 96361 (your initial service code would be your chemotherapy administration or other IV drug infusion administration).

Hydration service code 96360 (intravenous infusion, hydration ;intial, 31 min to 1 hour) is an INITIAL service code and Can only be billed if it is just that the initial service, and the hydration is running at least 31 minutes up to one hour, each additional hour would be reported w/ 96361.

The guidelines for reporting these services are in your CPT code book
also you can find information on your local Medicare web site, and CMS Claims processing manual chapter 12

Best Wishes!
Click to expand...

Thanks for responding. You said to use the add on code 96361, but in the CPT book under this code, it says "Code first (96360)", but I see it also says 96361 "INCLUDES hydration provided as a secondary or subsequent service after a different initial service..." These seem to contradict each other. Do these claims get paid without any problems?
 
Oops,:rolleyes: just read the answer in the the CMS manual...it clarifies that you CAN bill the add on with "another initial" service.

Thanks to everyone for their help.:)
 
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