HIM Insider: Forums

Re: coding iv push and hydration

Christina Benjamin — Fri, 28 Aug 2009 20:07:15 GMT

Here is an example: If the patient comes in for 2 injections of 2 different pain killers, the codes assigned should be 96374 and 96375. Associated hydration should not be billed at all.

Re: coding iv push and hydration

Rocky — Tue, 18 Aug 2009 20:27:30 GMT

Thanks for your response,this is facility(office setting).We give hydration and then we admin pain management 2-3 push each med.Please give me an example of how I should bil,please this is awful,my doctor is working hard.

Re: coding iv push and hydration

Christina Benjamin — Mon, 10 Aug 2009 23:13:05 GMT

There could be a number of things wrong. Without having documentation regarding the start and stop times and the substances administered it is hard to tell exactly, but just looking at your codes, it could be the following possibilities: (1) that the hydration is considered integral to the therapeutic injection, (2) modifier 59 and 76 are not being applied correctly, For example, I don't see a need for modifier 59 or 76 to be appended on the codes you listed (3) I don't know how you are sequencing these codes, nor do I know if you are billing for the hospital or for the physician, but you must follow the sequencing guidelines prescribed by CPT. For example, if you are billing for the facility, the first listed code should be 96374, then 96375 with the appropriate number of units for listed only for a different (not 2 units listed for 2 injections of the same substance), then the hydration code 96361with the appropriate number of units based on the hours of hydration provided. These are just a few suggestions without the benefit of having further detail about the exact nature of the services provided and the setting for which you are billing for (facility or professional).

Re: coding iv push and hydration

Christina Benjamin — Mon, 10 Aug 2009 23:03:20 GMT

Hi Deborah, What website are you referring to where you cannot open the powerpoints?

Re: coding iv push and hydration

Rocky — Fri, 07 Aug 2009 15:58:35 GMT

Rocky Jennings:

Please I'm constantly receiving rejections from Highmark Medicare Services,in ref to billing iv push and hydration below is an example how my claim look,PLEEEAAAASSSSEEEE HELP ME.

99213

96360 59 X1

96361 59 X6

96374

J1200

96375 76 X2

J2550

96375 76 X2

J2270

85025

36415

WHAT IS WRONG???????

Re: coding iv push and hydration

Rocky — Thu, 06 Aug 2009 16:30:59 GMT

Please I'm constantly receiving rejections from Highmark Medicare Services,in ref to billing iv push and hydration below is an example how my claim look,PLEEEAAAASSSSEEEE HELP ME.

99213

96360 59 X1

96361 59 X6

96374

J1200

96375 76 X2

J2550

96375 76 X2

J2270

85025

36415

WHAT IS WRONG???????

Re: coding iv push and hydration

Deborah Rumery — Fri, 31 Jul 2009 15:59:19 GMT

I am unable to open any of the ppts on that website.

Re: coding iv push and hydration

Patricia Haliscak — Wed, 15 Jul 2009 17:55:41 GMT

YES, I got it!!!

Thank you so much!!!!!! I feel much better now :-)

Patty H.

Re: coding iv push and hydration

Christina Benjamin — Wed, 15 Jul 2009 17:12:29 GMT

Exapmle: Zofran IVP up to 2 min.= 96374, NS 1000cc 45 min. 96361x1---no, only report 96360 as you have only 14 minutes beyond the minimum 31 minutes and you need 60 minutes beyond the first 31 minutes in order to bill 96361.

Zofran IVP up to 2 min. 96374, NS 1000cc 1hr. 45 min. 96361x1---correct

1 hour and 45 minutes is well over the 91 minutes minimum requirements for 96361, but not enough to bill a 2nd unit of 93631.

See below a chart that summarizes the time requirements for the hourly increments

1st hour 16-90 minutes (exception for hydration 31-90 min) initial service
2nd hour 91-150 minutes 1 unit of additional/subsequent service code
3rd hour 151-210 minutes 2 units of additional subsequent service code

and so on...

Let me know if this helps and feel free to contact me again for any further questions. My email contact is in my signature.

Re: coding iv push and hydration

Patricia Haliscak — Wed, 15 Jul 2009 16:24:57 GMT

O.k. Thank you ladies. I do have one more question and then I promise to leave you alone.

When reporting 96361 to identify hydration as a secondary or subsequent service after a different initial service is administered through the same IV access, what would you say the total time requirements would be to justify billing a 96361. Would you need to include the first hour from the inital 96360 then add 31 min beyond an hour for the add'l 96361?

Exapmle: Zofran IVP up to 2 min.= 96374, NS 1000cc 45 min. 96361x1

Zofran IVP up to 2 min. 96374, NS 1000cc 1hr. 45 min. 96361x1

or would 1hr. 45 min = 96361x2 ?

I hope you understand what I'm trying to say.

Thanks for you help.

Patty H.

Re: coding iv push and hydration

Christina Benjamin — Tue, 14 Jul 2009 13:28:22 GMT

Hi Patty,

For a facility setting, the hierarchy rules are what apply, not the "reason for the encounter" rules. You can see this guideline in the 2009 Professional Edition of CPT by AMA on page 435. "When these codes are reported by the facility, the following instructions apply. The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections."

I hope this helps.

Re: coding iv push and hydration

Christine Goans — Tue, 14 Jul 2009 11:28:32 GMT

Patty

We have had many requests for help with IV push and hydration please let me help you thru the maze.

Re: coding iv push and hydration

Christine Goans — Tue, 14 Jul 2009 11:24:42 GMT

Barbara

Check out my website for examples and training material for many coding issues www.medical-coding-resources.com and you can always email me at christine.goans@gmail.com or christine.goans@va.gov if you have any questions. I have over 20 years of experience

Re: coding iv push and hydration

Patricia Haliscak — Thu, 02 Jul 2009 13:13:14 GMT

Thank you Christina,

This is exactly what I have been trying to teach our nurses and it seems to be a difficult issue for them to understand.

My next question is in regard to hierarchy vs. reason for the encounter.

I attended an audioconfrence where the speaker chose "...the reason for the encounter" over the hierarchy rules and coded the initial hydration code over the IVP. I must be honest with you, I am not comfortable with that choice regardless of $ value. I understand if the patient is dehydrated, and only receives IV fluids, but if the chief complaint is severe vomiting with dehydration, wouldn't you code the treatment for the vomiting first IVP or IV as your initial followed by the add'l hydration code provided start and stop times are documented?

Is this "reason for the encounter" going to become more important than hierarchy rules? Is this the new way to code hydration? Do we have a choice?

Thank you for you help.

Patty H.

Re: coding iv push and hydration

Christina Benjamin — Thu, 02 Jul 2009 08:54:27 GMT

Hi Patty,

The hydration could not be coded because first, as you state, the time requirements are not met (only 10 of hydration only) and second, the hydration would be considered bundled because this is hydration which augments substance admin and that is considered integral to the therapeutic admin. The only thing that you could report in this instance would be the IV push.

The best way to document administrations of any substances is with a start and stop time: e.g. 9:00 NS hydration 10:00 NS hydration stopped. Then you could bill the hydration.

I hope this helps,

Christina