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Issue Number - Name
0137-IV Hydration Administration
Review Type
Complex
Claim Type
Outpatient Hospital
Region and State
JE
Date Approved
2019-01-08

Description

Necessity for administration of HYDRATION should be supported within medical documentation. Routine administration of IV fluids, pre/post operatively while the patient is NPO for example, without documentation supporting signs and/or symptoms including those of dehydration or fluid loss is not supported as medically necessary. It is important to distinguish the medical necessity of HYDRATION from the use of fluid administration intended only to initiate flow or to keep the vein open. When the sole purpose of the IV fluid administration is to establish and/or maintain vascular access or patency of the IV line, the service is neither diagnostic nor therapeutic and must not be separately reported.

Affected Codes

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

Applicable Policy References

Social Security Act: Section 1833(e) Payment of Benefits
42 CFR Section 405.980 (b) and (c) Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews.
42 CFR Section 405.986 Good cause for reopening
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 17, Section 10, 40, 70, and 90.2 
CPT Manual