Hydration with therapeutic IVPush

[Shelly7169]

I have been studying for the CHONC exam and ran across a contradiction to what I have been coding in a hydration and therapeutic IV Push scenario. I code for a free-standing infusion center.

I have been using the hierarchy:

Chemo Infusion
Chemo IV Push
Therapeutic Infusion
Therapeutic IV Push
Hydration
Injections

If a patient comes in for a two hour hydration of 1L NS and has a IV Push of Decadron for nausea.

I would code the administration as: 96374 for the IV Push and 96361 x2 for hydration.

According to the study materials this would be coded as 96360, 96361 for the hydration and 96375 for the IV Push.

I know we are to code the primary as the main reason the patient is coming in, but I thought it still had to follow the hierarchy. For instance, if the patient had a chemo IV Push and a therapeutic infusion, you would code the chemo as primary even though, generally an infusion would trump an IV Push.

Any help with documentation regarding this would be appreciated - especially if you found it in the CPT book. Thanks! ~Shelly

 

[SThebarge]

Hierarchy

I'm sure you seen contradictions from CPT to CMS in other instances, like consult codes. CMS and other providers want you to follow the hierachy rules while CPT wants you to follow (in physician office only) the reason for the visit (ie hydration). I agree it leads you to scratching your head and wondering if you are doing things correctly. If you billed a 96360 and a 96375, your payers will deny this because most payers follow the hierarchy rules. So for Billing, you need to follow the payer rules (which in turn become the general ruling), but for the exam you need to follow CPT.

 

[mitchellde]

read the CPT instructions carefully. It is different for facility vs physician. For physician coding you code the first the reason the patient is there so in your example the patient is there for hydration so the hydration is coded first and the IV push second, for the facility you follow the facility hierarchy and the IV push is coded first.

 

[traci.susong@gmail.com]

I have this very example all the time because patient gets a push while getting hydration. We are a hospital based facility so we follow hierachy and we would code 96374, 96360 and 96361 if addtional hours of hydration were needed.