Wiki What are the Requirements to charge for IV Hydration in the ER - Please Help!

[Pvdcoder]

Hello, I have a question as to what is required in order to charge for IV Hydration in the Emergency Room. The CPT books don't really go into depth about either of these questions. It is a 2 part question. 1st Question: We know that we first need a Physician order, Start and Stop Times, Reason for Hydration so it meets medical necessity and cannot run at the same time as a med infusion but do we need volume/rate and site to code? Is it Absolutely Required that we have the following:

1. Anatomic Site/Method of Administration of the Hydration infusion requirements (example Left Antecubital via IV)

2. Fluid Bag Volume/Amount example 1000 ml

3. Rate of Infusion?

Can we not charge for hydration if we do not have the Site, Volume and Rate? Or is it just recommended?

Here is a example we have from our orders we commonly see for Hydration in EPIC: We have no rate or site so can we code this?

Infusion Orders #1

Sodium Chloride (NS) 0.9 % bolus 1,000 mL
Total time: 2 Hours 19 Minutes

Running start: 11/21/2016 0836 Running stop: 11/21/2016 1055

Action Dose Rate Route Site Time Comment
New Bag 1,000 mL Intravenous 11/21/2016 0836
Stopped 0 mL 0 mL/hr Intravenous 11/21/2016 1055


2nd Question, can we charge for Hydration Bolus' and Lactated Ringers or does it have to say specifically that it is Normal Saline? Thank you in advance for any help you can offer

 

[DMeharg]

hydration coding help

Taking your questions in order.
I'm not sure what your first question is, as you are correct there must a doctors order. That order should give you everything you need in order to code the hydration, in addition to start and stop times. As for your second question there is a whole list of fluids that are considered hydration fluids. I think you can find them on through your local LCD or CMS. In short though lactated Rings, NS, saline, normal saline, and NS with a percentage behind it (ex NS 0.45%) are all considered hydration. I'd be careful of coding anything that has hydration and a medication together such as KCl with 0.45 %NS, or NS with KCl, these can get tricky and depending may or may not be hydration. Yes you can code a hydration bolus provide that is meets the timing requirements for coding a 96360 or 96361.
As for your other questions:
1 You MUST have a method of administration, aka route. Without this you can't code it. Good nursing documentation should include the site of the IV ( left AC etc.), but as far as I know you do not need that.
2 Yes you must have this. You have to have the dose, and rate in order to calculate the estimated time that a hydration should take. While the codes are time based and need documented start and stop times, the duration of administration should be appropriate to the order. Ex. 1000mL NS at 500mL/hr starts at 12:00 and runs to 14:00. This would be appropriate as it should take approximately 2 hours to infuse.
I would advise talking to your manager, and if possible collaborate with any nursing staff at your facility. They can help with understanding different rates, and calculating rate times. Rate and times can get very confusing.
3 Rate of infusion. IS absolutely necessary.

This can get confusing pretty fast as you can tell. My facility gave us A LOT of webinars, seminars and collaborative meetings with our CDI to help us understand. If its possible I'd see if your employer can get a webinar or two on injection and infusion coding.
Good Luck!

 

[Pvdcoder]

Thank you for your help. It does get confusing!!! The problem I face is that our orders will state for example, Sodium Chloride (NS) 0.9% bolus 1,000ml Time:3Hours 28 Minutes Running Start 11/05/16 1025 to Running Stop 11/05/16 1353 Does 1,000 ml Route IV Site Right Arm. This order does not include the rate and that is where I am conflicted. Can I still code for this or am I just not understanding it at all, lol?

 

[DMeharg]

Are you finding your orders in the MAR? If not I would look there. The MAR should have all the info that you need. If I only had the information that you have, I would not code it. Without the rate how do you know how long the hydration should go? if the hydration goes longer than it could indicate bad charting. The coding should represent what actually happened. Without the rate you don't really have a good idea of what was suppose to happen.