Wiki Hydration (96361) vs IV Start (96365)

[codegirl0422]

Hello,

21:51 11/12/2014 Site #1 started via IV in the right antecubital space with an 20g angiocath, with aseptic technique and good blood return; one attempt. Blood drawn: rainbow set.

22:00 11/12/2014 Zofran IVP 4 mg given over 4 minute(s) via site #1. Allergies verified and confirmed 5 rights. IV patency established. IV site checked: no pain, redness, or swelling. IV flushed thoroughly pre- and post-medication administration. IVP given by RN.

22:05 11/12/2014 Morphine IVP 4 mg given over 4 minute(s) via site #1. Allergies verified and confirmed 5 rights. IV patency established. IV site checked: no pain, redness, or swelling. IV flushed thoroughly pre- and post-medication administration.

23:33 11/12/2014 Started IV Fluids NS ; Initial bolus of 750 mL then 1000 mL/hr over 30 minute(s) via site #1 via IV pump. Allergies verified and confirmed 5 rights. IV patency established. IV site checked: no pain, redness, or swelling. IV flushed thoroughly pre- and
post-medication administration.

00:49 11/13/2014 IV Fluids NS Discontinued: bag #1 STOPPED upon discharge. Total amount infused: 800. IV patency established. IV site checked: no pain, redness, or swelling.
IV flushed thoroughly.

I coded this as
96374
96375
96361

But am being told to bill as
96374
96375
96365
96366

Should it be
96365
96375
96375
or not bill hydration at all?

dx:
Atypical chest pain
Renal insufficiency

This is what I was told: , you've been entering cpt code 96360 or 96361 which is IV Hydration. It should be 96365 which is IV start infusion for therapy, prophylaxis or diagnosis. This is used when you are starting an IV and also infusing medications. IV Hydration is ONLY used when the patient presents with Nausea vomiting, diarrhea, emesis, etc and we are only hydrating the patient not giving meds or any other type of treatment.

So then I asked another coder, and she didn't agree with the 96365 but said she wouldn't have been billed the 96361 at all since it is not medically necessary and the patient wasn't dehydrated (N/V, diarrhea, emesis).

I don't understand. I thought a drug had to be used with 96365. The way I was trained and information I can find, you would not bill 96365 for the start of hydration.

Is the hydration in the above case considered infusion for therapeutic, prophylactic (preventive), or diagnostic medication?

Any help would be greatly appreciated! Thanks in Advance

 

[sivagurulingam]

Hi,

I agree with your code 96374,96375,96361. I don't agree with 96365 which is used for drug infusion.

The zofran was a anti-emetic drug, so the provider give this drug for vomiting/prevent vomiting (i am not sure).

 

[jdean]

96361

You are using the correct codes of 96374, 96375, 96361

 

[codegirl0422]

Thank you.

So would you guys bill the 96361 even though the patient was not dehydrated or vomiting/diarrhea. I always thought you billed and if it doesn't meet medical necessity then you write it off.

 

[nlaaron]

Yes, bill it. You may not get paid, but you should stlill charge for what was done.

 

[ladondavis]

Late post but I agree, 96374 for zofran, 96375, for morphine push, 96361 for hydration whether it meets medical necessity or not, is the correct cpt code and is often not reimbursed by insurance. But we do not code for reimbursement, we code what is documented. Now we will subtract time from the hydration that is running at the same time as an IV push or IV infusion given.

 

[lsolway]

I too would use 96374 and 96375 … and 96361 if medically necessary. This is from CMS Noridian:
"Necessity for administration of HYDRATION should be supported within medical documentation...… When the sole purpose of the IV fluid administration is to establish and/or maintain vascular access or patency of the IV line, the service is neither diagnostic nor therapeutic and must not be separately reported." We look for any and everything to support the need for hydration. If we can't find anything, we don't report it.