Medication infusion and hydration billing

jkunsag

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Good evening,

I would greatly appreciate any advice on the following topic:

In the oncology department some patients receive hydration as well as their medication either due to dehydration, or due to the renal toxicity of the chemo. Hydration is given per the doctor's order. Previously our billers were consulted and advised that they should credit the hydration hours from the infusion. Now we have different opinions, and we are trying to clarify this issue.

In short the question is:
When a patient is receiving an infusion of medication and also IVF for hydration is the time of the hydration deducted from the infusion hours?

Thank you in advance,
Judith​
 

dja214

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Lakeland, FL
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Good evening,

I would greatly appreciate any advice on the following topic:

In the oncology department some patients receive hydration as well as their medication either due to dehydration, or due to the renal toxicity of the chemo. Hydration is given per the doctor's order. Previously our billers were consulted and advised that they should credit the hydration hours from the infusion. Now we have different opinions, and we are trying to clarify this issue.

In short the question is:
When a patient is receiving an infusion of medication and also IVF for hydration is the time of the hydration deducted from the infusion hours?

Thank you in advance,
Judith​
Hi, hope all is well!

I would not recommend coding both hydration and therapeutic and/or chemo, as it will result in a denial due to mass majority of your chemo drugs require a mixture of sodium chloride as indicated on the chemo packaging. Also, per CMS sodium chloride is deemed incidental to the chemo. The provider MUST document that they are to be run concurrent as well as the medical necessity:

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.
https://www.cgsmedicare.com/parta/pubs/news/2011/0211/011.html


When you are coding for infusion therapy you have to follow the hierarchy code rules. Regardless if the patient is receiving hydration due to dehydration you can not over lap 96361 with the therapeutic infusion that they are receiving. You may however bill for the hydration before the IV infusion and/or once all other IV infusions are complete. I do hope this makes sense, here's an example:​

You can not code the hydration:
hydration: 11:00 - 12:00 pm
Cisplatin: 11:15 - 12:30 pm

You can code the hydration:
hydration: 11:00 - 12:00 pm - 96361 (greater than 31 mins)
Camptosar: 12:15 - 2:30 pm - 96413, 96415

Hydration codes are intended to report IV infusions of pre-packaged fluid and/or electrolytes. They should not be used to report infusion of drugs or other substances.​

https://www.accc-cancer.org/publications/pdf/Oncology-Reimbursement-Coding-Update-2017.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN905712.pdf


Deanna Anderson, CPC, CPMA, CEMC
 
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jkunsag

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Thank you, Deanna! I will share this information. It makes sense to me. Thank you for your time!
 

Davieda Skobel

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Columbus Ohio
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i agree with Deanna timing is the key to this billing. When a Doctor orders hydration he usually means in addition to the prescribed chemo or other drugs ordered. It doesn't matter if it is run before or after the chemo/drugs but it most likely is not run at the same time.

Good luck!
Davieda
 
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