IV Infusions and Hydration coding guidelines

What are the guidelines for sequencing IVPD, IVP, and hydration infusions?
According to CPT for facility coding chemotherapy services are primary to
theraputic, prophylactic and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. Hydration codes are facility reporting only. For physician reporting initial code that best describes the primary reason for the encounter should be reported irrespective of the order in which the infusions or injections occur.

According to CPT we can report 96374 and 96361, but we cannot report 96360 and 96375 so 96374 is primary to 96360.

What are the guidelines for coding Hydration ie. how to determine hydration Vs Infusion?
Hydration may be billed separately only if it is given prior to or subsequent to drug infusion. If it is given concurrently to facilitate drug delivery, it is considered included in the drug infusion. If hydration is less than 30 minutes then it is not billable and the reson is that if it is less than that then it is not therapeutic and cannot be dehydration. Also look at the rate the fluids are running at, that will tell you if it is for hydration and not just for convenience. Therapeutic rate is 125cc/hr. Heplock and KVO(keep vein open) are not coded.

Saline soluton, D5W(dextrose 5% water), Hypotonic solution, Ringer Lactate, DW( Distilled water) are some of the solutions used along with other drug infusions and also as hydration. If any medication is used along with these then it is therapy 90765 not hydration 90760 and any saline fluid use is incidental and not to be reported.

Here are the CPT codes for infusion and hydration

IV infusion Bolus (IVPB) is an infusion that runs more than 15 minutes. Less than or upto 15 minutes is coded as IVP.

96365 Inital drug first hour
96366 Same drug each additional hour
96367 New drug each additional hour
96368 Used to indicate concurrent infusion of two or more drugs

Intravnous Push (IVP) is an infusion which runs up to 15 minutes
96374 (This code should not be used if 96365 or 96360 are in use instead use 96375 with appropriate units for number of drugs)

Salne infusion that run for more than 30 minutes are considered as theurapeutic hydration. Saline infusion for less than 30 minute is not coded.
96360 (This code should not be used if 96365 is in use instead use 96361 with appropriate units for number of hours of hydration)

Intramuscular Injection
96372 (Need to use 59 modifier in if used conjunction with above codes)


Anonymous said...

How do you code 1 amp of D50 given for hypoglycemia?

healthcare said...

Usually D50 is considered as hyderation therapy, but it can also be given as a theuraputic agent to treat certain conditions like hypoglycemia. In such cases, D50 or D5W is a theurapeutic infusion and should be coded by 96365 or 96374 series.

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