Tuesday, February 28, 2017

cpt 96360, 96361 - hydration therapy

CPT/HCPCS Codes

Group 1 Paragraph: N/A

Group 1 Codes:

96360 Hydration iv infusion init
96361 Hydrate iv infusion add-on



Coverage Indications, Limitations, and/or Medical Necessity



Indications

The clinical manifestations of dehydration or volume depletion are related to the volume and rate of fluid loss, the nature of the fluid that is lost, and the responsiveness of the vasculature to volume reduction. Rehydration with fluids containing sodium as the principal solute preferentially expands the extracellular fluid volume; a 1-liter infusion of normal saline may expand blood volume by about 300 ml. In general, an imbalance of less than 500 ml of volume is not likely to require intravenous rehydration.

Hydration services are indicated:

In documented volume depletion.

When performed in conjunction with chemotherapy, these CPT codes are covered only when infusion is prolonged and done sequentially [done hour(s) before and/or after administration of chemotherapy], and when the volume status of a patient is compromised or will be compromised by side effects of chemotherapy or an illness.

In some endocrine conditions with findings such as hypercalcemia, prolonged hydration can be medically necessary.

As an adjunct to the treatment of hypotension.
Limitations

Rehydration with the administration of an amount of fluid equal to or less than 500 ml is not reasonable and necessary.

These CPT codes are not to be used for routine IV drug injections.

Hanging of D5W or other fluid just prior to administration of chemotherapy is not hydration therapy and should not be billed with these codes.

When the sole purpose of fluid administration is to maintain patency of the access device, these infusion CPT codes should not be billed as hydration therapy.

Administration of fluid in the course of transfusions to maintain line patency or between units of blood product is not to be separately billed as hydration therapy.

Fluid used to administer drug(s) is incidental hydration and is not separately payable.

Rehydration via hydration therapy of extensively dehydrated patients can be accomplished in hours; therefore, the medical necessity of hydration beyond 12 hours must be documented in the medical record.

These CPT codes require the direct supervision of the physician or non-physician practitioner for the initiation of the service.




Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
N/A



Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

N/A




ICD-10 Codes that Support Medical Necessity


ICD-10 CODE DESCRIPTION

E11.649 - E11.69 - Opens in a new window Type 2 diabetes mellitus with hypoglycemia without coma - Type 2 diabetes mellitus with other specified complication

E13.649 - E13.69 - Opens in a new window Other specified diabetes mellitus with hypoglycemia without coma - Other
specified diabetes mellitus with other specified complication

E83.52 Hypercalcemia

E86.0 - E87.0 - Opens in a new window Dehydration - Hyperosmolality and hypernatremia

I95.9 Hypotension, unspecified

K29.00 - K29.91 - Opens in a new window Acute gastritis without bleeding - Gastroduodenitis, unspecified, with bleeding

K52.89 - K52.9 - Opens in a new window Other specified noninfective gastroenteritis and colitis - Noninfective
gastroenteritis and colitis, unspecified

K92.0 Hematemesis

N18.3 Chronic kidney disease, stage 3 (moderate)

O21.1 - O21.8 - Opens in a new window Hyperemesis gravidarum with metabolic disturbance - Other vomiting complicating
pregnancy

R11.10 - R11.12 - Opens in a new window Vomiting, unspecified - Projectile vomiting

R11.2 Nausea with vomiting, unspecified

R19.7 Diarrhea, unspecified

R41.0 Disorientation, unspecified

R41.82 Altered mental status, unspecified

R42 Dizziness and giddiness

R55 Syncope and collapse

Z51.11 Encounter for antineoplastic chemotherapy

Z91.89 Other specified personal risk factors, not elsewhere classified

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