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Medical Necessity for Hydration

  1. #1
    Hartford, CT
    Default Medical Necessity for Hydration
    Medical Coding Books
    Does anyone know if we need an order for Hydration services based on medical necessity? CPT codes 96360 and 96361. Any input would be greatly appreciated. Thanks.
    Susan Kelly, CPC

  2. #2
    You should have an order for all services provided.

  3. #3

    As per Jan 2010 Coding Edge issue - we need to have the below pre-requisites for Infusions:

    • An order and diagnosis for the service, which supports medical necessity;
    • The name and dose (units/concentration) of drugs or substances provided;
    • The route of administration (e.g., injection, push, infusion);
    • The time the service was provided, including start and stop times for infusions and whether the infusion was initially started via ambulance; and
    • The provider’s initials or signature.

    Hope this helps you,

    Thank You,

    Purnima S, CPC

  4. #4
    Columbia, MO
    The answer is yes you need an order for medical necessity. In the ER sometimes an IV is ordered out of routin rather than clear medical necessity. This is done to establish a medication route in case the patient crashes. Interqual crtieria was always if the rate is less than 63 CC per hour then it was only a convienience and not therepeutic for the patient, meaning we could not charge for it. I have also worked in facilities where the standard of care was 125CC per hour was the minimum therapeutic rate. You also of course must have a diagnosis that supports rehydration as being medically necessary. If the IV was started for the purpose of administering IV push meds then you do not bill hydration at all, you code only for an Initial IV push.

    Debra A. Mitchell, MSPH, CPC-H

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