Demystify Tricky Hydration Coding Rules to Improve Your Infusion/Injection Reporting

Find Out When You Should Append Modifier 59

If you find coding injection, infusion, and hydration services more than a little confusing, you’re not alone. The Medicare CPT guidelines are multi-layered and often puzzling. But if you don’t hone your coding skills, you’ll face a mountain of denied claims and lost reimbursement.

Essential: To successfully code injection and infusion services, you must first understand the applicable coding hierarchy and rules, says Gloryanne Bryant, in the AudioEducator session, “Injection/Infusion CPT Coding – Decrease Non-Compliance and Increase Reimbursement.” And coding injections and infusions are especially tricky in more non-routine scenarios, such as those not relating to chemotherapy.

First, Understand the Hierarchy

The basic hierarchy of the codes is infusion, injection, and hydration, which are time-based, according to a recent presentation by Michael Granovsky, MD, CPC, FACEP, president of LogixHealth. This means you must have start and stop times to properly classify and code the services.

Here’s how the three categories break down:

  1. Infusion involves an IV medication given over 15 minutes or more.
  2. Injection (or Push) involves medication given over less than 15 minutes.
  3. Hydration involves prepackaged fluids given through an IV (such as normal saline, potassium chloride in dextrose, sodium chloride, etc.) over the course of 31 minutes to one hour.

 

Do this: For hydration, you would typically report CPT code 96360 or 96361, according to a February 2018 training on hydration services by Noridian Healthcare Solutions, LLC. But you should not use these codes when the purpose of the IV is to keep the vein open before or after a therapeutic infusion, nor if it’s a free-flowing IV during chemotherapy or other therapeutic infusion.

Know When to Report 96360 & 96361

CPT code 96360 is the primary hydration code, which you should report for IV infusion hydration for the initial 31 minutes to one hour. This code encompasses infusion of prepackaged fluids and electrolytes, Noridian explained. Make sure you don’t report 96360 as a concurrent infusion service or for hydration that lasts 30 minutes or less.

Then, you would report code 96361 for each additional hour, listing this code separately in addition to the primary service code. Code 96361 reports the hydration time that extends beyond the initial 31 minutes to one hour.

Important: When you report 96361, make sure you’re capturing hydration provided secondary or subsequent to a different initial service, such as the initial hydration code 96360, the initial therapeutic infusion code (first hour) 96365, or injection code 96374, Noridian stated. Also, be sure that the additional hydration occurs using the same IV access as the initial service.

According to Janssen Care Path’s publication of the 2018 final Medicare CPT codes for drug administration services, here’s how the initial IV infusion service codes break down:

  • 96360 — IV infusion, hydration; initial, 31 minutes to 1 hour
  • 96365 – IV infusion for therapy/prophylaxis/diagnosis, initial, up to 1 hour
  • 96374 – Therapeutic/prophylactic/diagnostic IV push; single or initial substance or drug
  • 96409 – Chemo administration, intravenous push, single or initial substance/drug
  • 96413 – Chemo administration, IV infusion; up to 1 hr, single/initial substance or drug

Heed These Hydration Coding Tips

When coding 96361, you must choose a primary code for the date of service, Noridian instructed. And typically you will code only one “initial” service.

Caveat: The exception to this rule is when you have two separate IV sites. In this case, you would report the two primary codes for the same encounter, according to Noridian. Document the time and effort involved with providing the second IV site, and be sure to append modifier 59 to the code as a separate line item.

Example: A patient has two separately documented IV lines, which together equal 26 hours. In this scenario where two separate lines are used, you would bill each line with the appropriate administration code and number of units appropriate for the time the infusion is given, Noridian explained. Then, you would append modifier 59 to the second service that is separate and distinct.

Bottom line: Coding for infusions, injections, and hydration can be confusing to say the least. Dig deep into the CPT coding guidance and instructions for drug administration, and learn proper coding through helpful scenarios in Bryant’s educational session for AudioEducator. Whether you’re coding for services in the ER, inpatient, or hospital outpatient setting, you can’t afford to botch your coding, billing, and documentation compliance for hydration, injections, and infusions!

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