Infusion coding

DMeharg

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Hydration infusion guidelines state that when a drug is added to a bag of hydration fluid it's coded as a medication infusion. But the guidelines also state that the intent of the order is also a consideration.

I'm confused when a bag of hydration fluid with a drug listed in it should be coded as a hydration vs. a medication infusion.

At my facility we see hydrations listed 2 different ways. The first, is with the med listed first and then the hydration fluid, for example, Mg sulfate in NS at 50 Ml/hr IVPB, Vancomycin in D5W 1 gram at 200mL/hr, KCl in saline.We always interpreted these to medication infusions, because the medication was listed first. The second is with the hydration fluid listed first, for example NS with KCl 20 mEq/l infusion, NS with Mg. These we interpreted as hydrations since the hydration fluid is listed first.

Would both these types of orders be coded as medication? Does the size of the bag being infused matter?
Thanks!
 
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The size of the bag doesn't matter.
We consider NS with KCL and Mag to be for hydration and require the providers order it that way, otherwise they lose it. Our fluids are pre-packaged however, and that's where CPT guidance sounds off. Is the NS with medication at your facility being mixed by pharmacy specifically for that patient, or are these combo bags prepackaged?
 
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