Outpatient hospital services for hydration therapy have been approved for automated review. The issue for review is due to incorrect billing of hydration therapy with diagnosis codes that are not considered reasonable and medically necessary per the applicable Local Coverage Determination (LCD). Novitas Region C states will be affected. If your facility is in this region, it is time to embrace this now. Other states, I am sure that the RAC in your regions will be jumping on board shortly, if they haven’t already. For this particular automated review, the date of service is three years from the initial determination date. With more than 38 reasons when hydration therapy is medically necessary, CentraMed’s recommendation would include internal education to the coding staff. We believe the education would be beneficial in all regions, in an effort to correct coding issues before they become a problem and create a financial impact on the facility. Additionally, the following CPT and HCPCS codes are directly linked to the ICD-9-CM codes in this particular review.
| 96360 | Hydration iv infusion initial, 31 ,minutes to 1 hour |
| 96361 | Hydrate iv infusion add-on, each additional hour for infusion intervals of greater than 30 minutes beyond the first hour. |
| J7030 | Infusion normal saline solution, 1,000cc |
| J7040 | Infusion normal saline solution, sterile (500 ml=1 unit) |
| J7042 | 5% dextrose/normal saline (500 ml=1 unit) |
| J7050 | Infusion normal saline solution, 250cc |
| J7060 | 5% dextrose/water (500 ml=1 unit) |
| J7070 | Infusion D-5-W, 1000 cc |
| J7120 | Ringers lactate infusion, up to 1000cc |
Just a few simple steps can make a difference.
- Review Charge Description Master (CDM) for accuracy of the CPT and HCPCS codes as well as the descriptions
- Educate all staff responsible for charging these services through the (CDM) hard coding and all staff responsible for soft coding of the injection and infusion hierarchy
- Supplies used should be consistently charged
- Coders should review charts for medical necessity and the appropriateness of coding for infusion therapy, especially when other services are being performed during the patients stay.
This is important because other codes could impact the appropriateness of coding for such services in conjunction with hydration therapy.
It is also important to remember that facilities don’t get paid for what is done. They get reimbursed for what is performed, documented, and coded as reasonable and medically necessary.
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