Let’s suppose IV hydration is initiated on a patient, running consecutively and started at 11:45pm on day 1 until 1:20 am on day 2. That’s one hour and 35 minutes of total running time by the clock, so it’s worth one initial and one additional CPT hour. But only 15 minutes of this infusion occurred on the first date of service. Hydration services must be greater than 31 to 60 minutes in duration to code a CPT hour’s worth.
So what do we do with the 15 minutes infused on day one?
Would this be coded as 96360 with the DOS of the starting date (when the infusion was initiated) and 96361 with the DOS of the second day after midnight? Or would it be correct to ignore the service which occurred on day one, as it only ran for 15 minutes for that date of service, and only code 96360 for the second date of service, as only one hour and 20 minutes of infusion occurred on that date? Or would we capture 96360 and 96361 both on day 2 as that’s when each of the services were completed, ie: the first full hour and the >31 minutes comprising the second hour?
From CMS, there is this:
“Drug administration services are to be reported with a line item date of service on the day they are provided. In addition, only one initial drug administration service is to be reported per vascular access site per encounter, including during an encounter where observation services span more one calendar day.”
and similarly –
“Drug administration services are to be reported with a line-item date of services on the day they are provided. In addition, beginning in CY 2007, hospitals should report only one initial drug administration service, including infusion services, per encounter for each distinct vascular access site, with other services through the same vascular access site being reported via the sequential, concurrent or additional hour codes.”
For coding, apply the conventional practice of ascribing the starting time and date as the date the service was initially provided, just as one would do for a surgery CPT, ED visit E/M, etc. So the answer is: 96360 with DOS 1 (before midnight), and 96361 with DOS 2 (after midnight).
Ed O'Beirne, CCS, CHDA, CHPS, CDIP, PA, MHS
Director of Clinical Integration
Ed has been in healthcare his entire career with 15 years as a clinician and 11 years in a variety of HIM coding related roles. After 4 years as a respiratory therapist and 11 years as an emergency medicine Physician Assistant, the fascination with reading, analyzing, and translating medical documentation overcame his desire to perform patient care. For a guy who with a habit for reading the Encyclopedia Brittanica, the Merck Manual, and medical records just for fun, HIM became a natural fit.
Documentation and coding audits are firmly in Ed’s skillset but educating coders is what really makes him tick. He is known for effectively integrating anatomy, physiology, pathophysiology, medicine, and detailed procedural descriptions into his coding education in all forms.
He is a BS graduate in Biology from Virginia Commonwealth University and Master of Health Sciences from Duke University. Obsessed with aviation, he has a pilot’s license, 1000 skydives, owned an ultralight for several years, and currently designs, builds, and flies radio controlled airplanes and drones. Ed lives in Virginia with his wife and two kids, and plays outside with them as much as possible.