IV Hydration Quarterly Results of TPE Review - JE Part A
IV Hydration Targeted Probe and Educate Review Results
The Jurisdiction E, Part A Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 96360 – Intravenous infusion, hydration; initial, 31 minutes to 1 hour and CPT® 96361 – Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure). The quarterly edit effectiveness results from January 1, 2020 through March 31, 2020 are as follows:
Top Denial Reasons
- Documentation does not support medical necessity.
- Documentation does not support IV hydration was provided per coding definition.
- Documentation does not support number of units billed.
- Drugs, Biologicals and Injections Documentation Requirements
- Local Coverage Article: Hydration Services (A54635)
- CMS Internet Only Manual (IOM), Publication 100-02, Chapter 15, Section 50
- CMS IOM, Publication 100-04, Chapter 4, Section 230.2(B)
- CMS IOM, Publication 100-04, Chapter 12, Section 30.5
- CMS IOM, Publication 100-04, Chapter 17
Medical Necessity for Hydration
Per the Current Procedural Terminology (CPT®) manual, CPT®) codes 96360 and 96361 are intended to report a hydration IV infusion to consist of a pre-packaged fluid and electrolytes but are not used to report infusion of drugs or other substances. Necessity for administration of hydration should be supported within medical documentation. Routine administration of IV fluids without documentation supporting signs and/or symptoms of dehydration, fluid loss, inability to ingest fluids, abnormal vital signs and/or laboratory studies is not supported as medically necessary. Additionally, to qualify as hydration, the rate of infusion should support performance of this service for rapid replenishment of fluids. Refer to the Local Coverage Article: Hydration Services A54635 for additional information.
Start and Stop Times
Per guidelines found in the Current Procedural Terminology (CPT®) manual, when reporting codes for which infusion time is a factor, use the actual time over which the infusion is administered. The CPT® manual includes descriptors and guidelines when billing codes for hydration, chemotherapy, infusion, or injections. In order to evaluate the actual time of a hydration or infusion/injection services, it is important that the medical record include both start and stop times of administration to support the services billed.
Last Updated Thu, 21 May 2020 20:54:05 +0000