Wiki Infusion with hydration

[hsmith67]

Patient received infusion of Remicade. Remicade is administered with NS. Patient has Medicare Advantage plan.

Do I bill:
a) 96413/96415 based on time of infusion for the Remicade, or
b) 96360/96361 based on time of infusion of NS, or
c) both 96413/96415 and 96360/96361 based on time of infusion of Remicade and NS.

Thanks,

Hunter Smith, CPC

 

[sls314]

Patient received infusion of Remicade. Remicade is administered with NS. Patient has Medicare Advantage plan.

Do I bill:
a) 96413/96415 based on time of infusion for the Remicade, or
b) 96360/96361 based on time of infusion of NS, or
c) both 96413/96415 and 96360/96361 based on time of infusion of Remicade and NS.

Thanks,

Hunter Smith, CPC

You'd only bill for the Remicade.

If NS is part of the standard treatment protocol, you wouldn't bill separately for it. You only bill for medically necessary hydration.

Here's an article from CMS that explains it: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53778

Hydration Therapy

Hydration must be medically reasonable and necessary. If documentation supports a clinical condition that warrants hydration, other than one brought about by the requirements of a procedure, the hydration may be separately billable.

When fluids are used solely to administer the drugs, i.e. the fluid is merely the vehicle for the drug administration, the administration of the fluid is considered incidental hydration and not separately billable.

CPT® instructions require the administration of a hydration infusion of more than 30 minutes in order to allow the coding of hydration as an initial service. Hydration of less than 30 minutes is not separately billable. The charges for an administration of 30 minutes or less should be reported with an appropriate revenue code, but without a HCPCS or CPT® code. Hydration therapy of 30 minutes or more should be coded as initial, 31 minutes to one hour, and each additional hour should be listed separately in addition to the code for the primary infusion/injection.

 

[hsmith67]

You'd only bill for the Remicade.

If NS is part of the standard treatment protocol, you wouldn't bill separately for it. You only bill for medically necessary hydration.

Here's an article from CMS that explains it: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53778

Hydration Therapy

Hydration must be medically reasonable and necessary. If documentation supports a clinical condition that warrants hydration, other than one brought about by the requirements of a procedure, the hydration may be separately billable.

When fluids are used solely to administer the drugs, i.e. the fluid is merely the vehicle for the drug administration, the administration of the fluid is considered incidental hydration and not separately billable.

CPT® instructions require the administration of a hydration infusion of more than 30 minutes in order to allow the coding of hydration as an initial service. Hydration of less than 30 minutes is not separately billable. The charges for an administration of 30 minutes or less should be reported with an appropriate revenue code, but without a HCPCS or CPT® code. Hydration therapy of 30 minutes or more should be coded as initial, 31 minutes to one hour, and each additional hour should be listed separately in addition to the code for the primary infusion/injection.

Exactly what I was thinking. Thanks so much for the clarification as well as the link to the CMS article.