The Central Office on HCPCS continues to receive inquiries regarding the appropriate coding of hydration services, specifically pre-packaged fluids and electrolytes. Many of the questions center on the administration of hydration where potassium or other substances are added to a bag of normal saline. In these instances we find that some coders are reporting this as hydration while others are reporting the administration as an injection or infusion of a therapeutic or prophylactic substance.
Over the years we have had many discussions regarding the reporting of injections and infusions of substances/drugs administered for therapeutic, prophylactic or diagnostic purposes. Now it appears based on the inquiries we’ve received some clarity is needed for consistent and accurate reporting of hydration and therapeutic administration services.
What is Hydration?
Hydration is defined as the replacement of necessary fluids via an IV infusion which consists of pre-packaged fluid and electrolytes. Some of the solutions utilized in administration of hydration
- Saline solutions,
- D5W(dextrose 5% water),
- Hypotonic solution,
- Ringer Lactate, and
- DW( Distilled water)
Reporting of Hydration Services
Hydration services are reported with CPT Code 96360, Intravenous infusion, hydration; initial 31 minutes to 1 hour, and CPT code 96361, Intravenous infusion, hydration; each additional hour. These codes are intended to report an intravenous hydration infusion consisting of prepackaged fluid and electrolytes and would not be used to report infusions of drugs or other substances.
A hydration service provided for less than 30 minutes is not considered therapeutic and would not be reportable.
Here are a few other instances where hydration services would not be reportable:
- When the fluid is used to “keep open” (ie., for flushing) the IV line prior or subsequent to another infusion;
- When the fluid is used as the diluent to mix the drug (ie., the fluid is the vehicle in which the drug is administered);
- When the purpose of the infusion is to accommodate a therapeutic IV piggyback through the same IV access as a free-flowing IV to safely infuse the agent;
- When IV fluids are allowed to continue to run during the administration of the chemotherapy or therapeutic agent. Please note: If the hydration services were administered before or after a therapeutic or prophylactic drug infusion and chemotherapeutic service, the hydration administration can be appropriately reported.
The hydration codes were created to report specific therapeutic interventions undertaken when a patient presents with dehydration and volume loss requiring the administration of necessary intravenous fluid. The medical necessity for hydration services should be clearly documented in the health record. These codes should not be used to report infusion of drugs or other substances other than intravenous infusions of prepackaged fluid with or without electrolytes.
The Reporting of Hydration Versus Therapeutic Prophylactic Services
The reporting of hydration codes versus therapeutic/prophylactic injection and infusion codes would be dependent on the reason for the encounter and whether any other injection or infusion services are performed. If the purpose of the infusion is for rehydration with no other IV infusion service provided then it would be appropriate to report a hydration code for the initial service provided.
For example: A patient is seen at our facility because of dehydration due to continuous nausea with vomiting. She is given a prepackaged solution of 1,000 cc’s of normal saline with potassium added to the bag which was prepared by the pharmacy. The hydration is administered for an hour and 15 minutes.
CPT code 96360, Intravenous infusion, hydration; initial, 31 minutes to 1 hour, would be reported for this encounter because there was no other intravenous infusion service performed during this encounter and the primary reason for the encounter was to administer the fluids and electrolyte(s) due to fluid loss from the patient’s continuous nausea with vomiting. The additional 15 minutes would not be reported due to the hydration services not being greater than 30 minutes past the initial hour.
When reporting an initial infusion service for outpatient facilities, coders must remember to apply the appropriate hierarchy for infusion, injection, and hydration services performed. The reporting hierarchy for facility reporting remains as follows:
The initial (first listed) code should be selected as:
- Chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services
- Therapeutic, prophylactic, and diagnostic services, are primary to hydration services
- Infusions are primary to pushes, and
- Pushes are primary to injections
Let’s take a look at a few questions regarding the coding and reporting of hydration services:
This patient arrived in the emergency department and received an intravenous hydration infusion with Vancomycin for over 1 hour. How would the hydration and administration of Vancomycin be reported?
Report CPT code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis; (specify substance or drug) initial, up to 1 hour, for the service provided. This hydration service would be considered integral to the drug administration and not separately reported.
A 55 year-old diabetic female is brought to the emergency department due to acute altered level of consciousness. Blood glucose level initially is 42 mg1dL. The patient is promptly administered dextrose 50% (D50) 25g IV push for the altered level of consciousness at 08:29 am. Her blood glucose at 08:37 is 219 mgl dL. What is the correct CPT code for the D50?
No code for the administration of hydration would be reported in this case. Based on the information provided, this patient received an intravenous push of dextrose 50% (D50). Guidelines for reporting hydration services specifically state that if hydration is 30 minutes or less it would not be reported.
A patient was seen at our facility for low potassium level. He received 1 hour of intravenous hydration fluid mixed with potassium for treatment of the patient’s low potassium level. What would the correct CPT code be for this encounter?
Report CPT code 96365, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, for the intravenous infusion of potassium.
It would be inappropriate to report the hydration code for this encounter because the infusion was provided primarily for treatment of the patient’s low potassium level.