I am still confusing on billing for iv push and hydration codes.

 

if the patient was given phenegan(90774) and normal saline (90760).

Can i bill for both or can do i have to only bill for one initial?

Hi Rolunda, When you bill IV hydration along with IV pushes, you always have to report the IV push as the initial code. I just answered this question for an Advance Q&A and here is the answer that I provided.

According to the CPT hierarchy, the initial code must be 90774. Following that code, 90761 must be assigned for the hydration. The CPT hierarchy is based on the instructional notes found in the Professional Edition of CPT by the American Medical Association and these official CPT guidelines give detailed instructions on which codes should be assigned together.

Under the 90761 code, the following instructional note is provided: “Report 90761 to identify hydration if provided as a secondary or subsequent service after a different initial service [90760, 90765, 90774, 96409, 96413] is administered through the same IV access.”

The instruction note is provided under the code 90775: “Use 90775 in conjunction with 90765, 90774, 96409, 96413.” This note indicates that this code cannot be assigned with any of the hydration codes and thus the hierarchy is established that hydration must be reported as a subsequent service when other injection/infusion services are provided.

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Christina Benjamin
Independent Coding & Education Consultant
Email: cmbenjamin@bellsouth.net
www.tools4coding.com

Here is some additional information that I wanted to add from a question I received on this topic.

  

I received the following comment regarding the new 2008 instructional notes in CPT for injections and infusions “The statement, “Infusions are primary to pushes, which are primary to injections,” appears to indicate that hydrations services are primary to IV pushes…as hydrations are infusion services.”

 

Here is my answer:

The intent of the CPT statement quoted above is to mean that infusions (excluding hydration) are primary to injections.  CPT does not classify hydration to mean a type of infusion.  Hydration is a term that is used separately and is not classfied along with infusion.

 
The second question was regarding Medicare reimbursement: "In addition to the coding manual being ambiguous, another significant issue is that Medicare reimbursement and relative weights do not appear to align with an IV push service being primary to a hydration (see below).   It would be very easy to go ahead and just code IV pushes primary to hydrations, but Medicare reimbursement for these services makes no sense.... "  The person went on to explain how Medicare pays more for a single hydration of 1 hour duration than for an injection plus an hour infusion.

 

Here is my answer: we don’t base our coding on the reimbursement methodologies, therefore, we must code the services based on the guidelines despite reimbursement implications.  This is an issue that CMS/Medicare is going to have to resolve.

 Christina

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Christina Benjamin
Independent Coding & Education Consultant
Email: cmbenjamin@bellsouth.net
www.tools4coding.com

I have a powerpoint and some training material that might help you

Subscribe to Medical_Coders_Resource_Networking_Group

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Christine Goans & Company
www.medical-coding-resources.com
Coding Smarter Office Support Plus
Consulting and Educational services

I WOULD LOVE A COPY OF YOUR POWERPONT AND SOME TRAINING MATERIAL

Hi Barbara,

I am not Christine Goans, but I just happened to see your question and would be happy to send along several resources that my colleagues and I have developed for injection and infusion coding.  Just email me at cmbenjamin@bellsouth.net.
 

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Christina Benjamin
Independent Coding & Education Consultant
Email: cmbenjamin@bellsouth.net
www.tools4coding.com

Hi Christina,

I hope you can give me your thoughts on the proper way to document hydration.

Hydration is given first followed by an IVP before the first 31 minutes of hydration was completed.

Example: 9:00  NS 1000 cc hydration started    9:10 Zofran IVP given over two minutes (no stop time documented)

Would you or could you code hydration and why?

I would not be comfortable with coding it because I have no way to justify the time requirements needed to bill 96360 or 96361.

I hope you can give me your opinion on this, and if the statement, (given over 1 hr. would make a difference)

Thank you .

Patty H.

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
 

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Christina Benjamin
Independent Coding & Education Consultant
Email: cmbenjamin@bellsouth.net
www.tools4coding.com

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. 

 

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

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Christine Goans & Company
www.medical-coding-resources.com
Coding Smarter Office Support Plus
Consulting and Educational services

Patty

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

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Christine Goans & Company
www.medical-coding-resources.com
Coding Smarter Office Support Plus
Consulting and Educational services

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. 

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Christina Benjamin
Independent Coding & Education Consultant
Email: cmbenjamin@bellsouth.net
www.tools4coding.com

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

or

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. 

 

                  

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.

or

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.

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Christina Benjamin
Independent Coding & Education Consultant
Email: cmbenjamin@bellsouth.net
www.tools4coding.com

YES, I got it!!! 

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

Patty H.