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.
Independent Coding & Education Consultant