Tuesday, February 28, 2017

cpt 96360, 96361, 93365 - 96372, 96376 - hydration therapy

CPT/HCPCS Codes

Group 1 Paragraph: N/A

Group 1 Codes:

96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour

96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)

96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

96366  Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

96367 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)

96368 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)

96369 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)

96370 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

96371 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure)

96372 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

96373 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intraarterial

96374 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug

96375 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

96376 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)

96377 Application of on-body injector (includes cannula insertion) for timed subcutaneous injection

96379 Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion



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.


Infusion Services

CHEMO THERAPEUTIC HYDRATION INITIAL 96413 96365 96360 Each Additional Hour +96415 +96366 +96361 Subsequent +96417 +96367 Concurrent +96368 Push Initial 96409 96374 Subsequent Push New +96411 +96375 Subsequent Push Same +96376 (Facility only – 30 m

Hydration Intravenous Infusion

• 96360-Intravenous infusion, hydration; initial, 31 i t t 1h 28 minutes to 1 hour
• 96361- Intravenous infusion, hydration; each additional hour

Example # 3

Chose the initial code based on the reason for the encounter. Answer: 34
• Non-chemo IV push = 96375 (each additional)
• 2 hours hydration infusion = 96360 x1 (initial) and 96361 x 1 (each additional)

Blood Draws, Phlebotomy and Port Flushes Phlebotomy

• Services necessary to perform the phlebotomy (CPT codes 36000, 36410, 96360-96376) are included in the procedure 49 the procedure.
– 36000-IV start
– 36410-Venipuncture, age 3 years or older, necessitating physician’s skill, for diagnostic or therapeutic purposes (not to be used for routine venipuncture)
– 96360-96376-Hydration infusions and Therapeutic, prophylactic and diagnostic injections and infusions

E/M Service Performed the Same Day as an Infusion Service The exception to this is CPT code 99211 (level one established patient visit) 55 The drug and chemotherapy administration CPT codes 96360-96375 and 96401-96425 include the work and practice expenses of CPT code 99211

Hydration Infusion Clarification Both the “initial” and “each additional hour” hydration codes require more than 30 minutes of infusion time be documented in order to bill services. If time is less then 31 minutes-no 60 service is reported.

• 96360-initial, 31 minutes to one hour hydration infusion
• 96361- each additional hour, (31 minutes to one hour) hydration infusion



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



Policy from OXford insurance



This Oxford reimbursement policy is aligned with the American Medical Association (AMA) Current Procedural Terminology (CPT®) and Centers for Medicare and Medicaid Services (CMS) guidelines. This policy describes reimbursement for therapeutic and diagnostic Injection services (CPT codes 96372-96379) when reported with evaluation and management (E/M) services. This policy also describes reimbursement for Healthcare Common Procedure Coding System (HCPCS) supplies and/or drug codes when reported with Injection and Infusion services (CPT codes 96360-96549 and HCPCS code G0498). For the purpose of this policy, same individual physician, hospital, ambulatory surgical center or other health care professional is the same individual, hospital, ambulatory surgical center or other health care professional rendering health care services reporting the same Federal Tax Identification number.

Exceptions

CPT 99211: E/M service code 99211 will not be reimbursed when submitted with a diagnostic or therapeutic Injection code, with or without modifier 25. This very low service level code does not meet the requirement for "significant" as defined by CPT, and therefore should not be submitted in addition to the procedure code for the injection. CPT 99381-99429: The Preventive Medicine codes (99381-99429) do not need modifier 25 to indicate a significant, separately identifiable service when reported in addition to the diagnostic and therapeutic injection service. The Preventive Medicine codes include routine services such as the ordering of immunizations or diagnostic procedures. The performance of these services is to be reported in addition to the Preventive Medicine E/M code. Therefore, diagnostic and therapeutic Injections can be reported at the same time as a Preventive Medicine code without appending modifier 25.

For additional information, refer to the Questions and Answers section, Q&A2, Q&A3 and Q&A6.
? CMS POS Database
? E&M Codes for Injection Codes 96372-96379

Injection and Infusion Services (96360-96549 and G0498) and HCPCS Supplies Consistent with CPT guidelines, HCPCS codes identified by code description as standard tubing, syringes, and supplies are considered included when reported with Injection and Infusion services (CPT codes 96360-96549 and HCPCS code G0498) and will not be separately reimbursed.

Drug Codes

Oxford reimbursement policy is aligned with CMS and will separately reimburse for the HCPCS drug code when submitted with Injection or Infusion codes (CPT codes 96360-96549 and HCPCS code G0498) by the Same Individual Physician or Other Health Care Professional on the same date of service under the guidelines of this policy.

APPLICABLE CODES

The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies may apply.

CPT Code Description

96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)

96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour 96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

96367 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)

96368 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)

96369 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)

96370 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

96371 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure)

96372 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

96373 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intraarterial

96374 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug

96375 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

96376 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)





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

No comments:

Post a Comment

Popular Posts