I need some help determining how to appropriately bill for a hydration infusion with chemotherapy.
Patient received hydration from 1050-1325 and chemotherapy from 1120-1305. That means that there was a 29-minute span prior to chemo and a 20-minute span after chemo that was not concurrent. I found references saying you can combine time, but it doesn’t go into specifics to clarify when the time pre is less than 31 and post is less than 31 but combined they meet the requirement of 31 minutes.
I had a payor reject 96361 stating:
“While it is noted that hydration was provided for 29 minutes prior to a medication infusion, and hydration was continued for an addition 20 minutes after the medication was infused; these times may not be added together to support the 31-minute time requirement for HCPCS I procedure 96361. While the IV fluids ran continuously during the medication infusion, the intravenous fluids are not considered hydration when concurrent with a medication infusion; this interrupts the continuous infusion of intravenous fluids. The hydration before and after the medication infusion cannot be combined to satisfy the 31-minute time requirement. Considering the hydration service was interrupted by intravenous medication administration in the same line; it would not be appropriate to add together the pre and post hydration times together.”
References:
Any fluid administered concurrently with chemotherapy or other drug infusion is not separately reported as hydration, as there is no charge for “concurrent hydration” or “incidental hydration.” According to the Medicare Correct Coding Policy Manual (Chapter 11)
Hydration may also be provided multiple time within a single encounter. In this scenario, CPT Assistant, June 2007 instructs,
“If Hydration is performed multiple times during the same drug administration service, such as before and after chemotherapy, the total hydration time is used for code reporting. For example, if the patient had 45 minutes of hydration prior to chemotherapy and 60 minutes of hydration after chemotherapy was completed, code 96361 would be reported with 2 units.
Patient received hydration from 1050-1325 and chemotherapy from 1120-1305. That means that there was a 29-minute span prior to chemo and a 20-minute span after chemo that was not concurrent. I found references saying you can combine time, but it doesn’t go into specifics to clarify when the time pre is less than 31 and post is less than 31 but combined they meet the requirement of 31 minutes.
I had a payor reject 96361 stating:
“While it is noted that hydration was provided for 29 minutes prior to a medication infusion, and hydration was continued for an addition 20 minutes after the medication was infused; these times may not be added together to support the 31-minute time requirement for HCPCS I procedure 96361. While the IV fluids ran continuously during the medication infusion, the intravenous fluids are not considered hydration when concurrent with a medication infusion; this interrupts the continuous infusion of intravenous fluids. The hydration before and after the medication infusion cannot be combined to satisfy the 31-minute time requirement. Considering the hydration service was interrupted by intravenous medication administration in the same line; it would not be appropriate to add together the pre and post hydration times together.”
References:
Any fluid administered concurrently with chemotherapy or other drug infusion is not separately reported as hydration, as there is no charge for “concurrent hydration” or “incidental hydration.” According to the Medicare Correct Coding Policy Manual (Chapter 11)
Hydration may also be provided multiple time within a single encounter. In this scenario, CPT Assistant, June 2007 instructs,
“If Hydration is performed multiple times during the same drug administration service, such as before and after chemotherapy, the total hydration time is used for code reporting. For example, if the patient had 45 minutes of hydration prior to chemotherapy and 60 minutes of hydration after chemotherapy was completed, code 96361 would be reported with 2 units.