Retired Local Coverage Article Billing and Coding

Billing and Coding: Hydration Therapy

A56634

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56634
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Hydration Therapy
Article Type
Billing and Coding
Original Effective Date
07/11/2019
Revision Effective Date
12/10/2021
Revision Ending Date
03/01/2023
Retirement Date
03/01/2023
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34960, Hydration Therapy. Please refer to the LCD for reasonable and necessary requirements.


Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Providers should refer to the applicable AMA CPT Manual to assist with proper reporting of these services.

When administering multiple infusions, injections or combinations, report one “initial” service code (CPT code 96360) unless protocol requires that two separate IV sites must be used.

If more than one “initial” service code (CPT code 96360) is to be billed on the same date of service (patient has to come back for a separately identifiable service on the same day or has two IV lines per protocol), the service should be reported utilizing the most appropriate modifier.

Report the infusion code for “each additional hour” (CPT code 96361) only if the infusion interval is greater than 30 minutes beyond the one-hour increment.

Utilization Parameters

CPT code 96360 with/without CPT code 96361 will be paid once per session.

Medicare would not expect to see CPT code 96360 billed more frequently than once per day.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital - Swing Beds
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
028x Skilled Nursing - Swing Beds
071x Clinic - Rural Health
077x Clinic - Federally Qualified Health Center (FQHC)
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0250 Pharmacy - General Classification
0258 Pharmacy - IV Solutions
0260 IV Therapy - General Classification
0263 IV Therapy - IV Therapy/Drug/Supply/ Delivery
045X Emergency Room - General Classification
076X Specialty Services - General Classification
N/A

CPT/HCPCS Codes

Group 1

(10 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
96360 Hydration iv infusion init
96361 Hydrate iv infusion add-on
J7030 Normal saline solution infus
J7040 Normal saline solution infus
J7042 5% dextrose/normal saline
J7050 Normal saline solution infus
J7060 5% dextrose/water
J7070 D5w infusion
J7120 Ringers lactate infusion
J7121 5% dextrose in lac ringers
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(101 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070, J7120 and J7121:

Group 1 Codes
Code Description
D57.00 Hb-SS disease with crisis, unspecified
D57.01 Hb-SS disease with acute chest syndrome
D57.02 Hb-SS disease with splenic sequestration
D57.03 Hb-SS disease with cerebral vascular involvement
D57.09 Hb-SS disease with crisis with other specified complication
D57.211 Sickle-cell/Hb-C disease with acute chest syndrome
D57.212 Sickle-cell/Hb-C disease with splenic sequestration
D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement
D57.218 Sickle-cell/Hb-C disease with crisis with other specified complication
D57.219 Sickle-cell/Hb-C disease with crisis, unspecified
D57.411 Sickle-cell thalassemia, unspecified, with acute chest syndrome
D57.412 Sickle-cell thalassemia, unspecified, with splenic sequestration
D57.413 Sickle-cell thalassemia, unspecified, with cerebral vascular involvement
D57.418 Sickle-cell thalassemia, unspecified, with crisis with other specified complication
D57.419 Sickle-cell thalassemia, unspecified, with crisis
D57.431 Sickle-cell thalassemia beta zero with acute chest syndrome
D57.432 Sickle-cell thalassemia beta zero with splenic sequestration
D57.433 Sickle-cell thalassemia beta zero with cerebral vascular involvement
D57.438 Sickle-cell thalassemia beta zero with crisis with other specified complication
D57.451 Sickle-cell thalassemia beta plus with acute chest syndrome
D57.452 Sickle-cell thalassemia beta plus with splenic sequestration
D57.453 Sickle-cell thalassemia beta plus with cerebral vascular involvement
D57.458 Sickle-cell thalassemia beta plus with crisis with other specified complication
D57.811 Other sickle-cell disorders with acute chest syndrome
D57.812 Other sickle-cell disorders with splenic sequestration
D57.813 Other sickle-cell disorders with cerebral vascular involvement
D57.818 Other sickle-cell disorders with crisis with other specified complication
D57.819 Other sickle-cell disorders with crisis, unspecified
E11.618 Type 2 diabetes mellitus with other diabetic arthropathy
E11.620 Type 2 diabetes mellitus with diabetic dermatitis
E11.621 Type 2 diabetes mellitus with foot ulcer
E11.622 Type 2 diabetes mellitus with other skin ulcer
E11.628 Type 2 diabetes mellitus with other skin complications
E11.630 Type 2 diabetes mellitus with periodontal disease
E11.638 Type 2 diabetes mellitus with other oral complications
E11.649 Type 2 diabetes mellitus with hypoglycemia without coma
E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.69 Type 2 diabetes mellitus with other specified complication
E13.620 Other specified diabetes mellitus with diabetic dermatitis
E13.621 Other specified diabetes mellitus with foot ulcer
E13.622 Other specified diabetes mellitus with other skin ulcer
E13.628 Other specified diabetes mellitus with other skin complications
E13.638 Other specified diabetes mellitus with other oral complications
E13.649 Other specified diabetes mellitus with hypoglycemia without coma
E13.65 Other specified diabetes mellitus with hyperglycemia
E13.69 Other specified diabetes mellitus with other specified complication
E83.52 Hypercalcemia
E86.0 Dehydration
E86.1 Hypovolemia
E86.9 Volume depletion, unspecified
E87.0 Hyperosmolality and hypernatremia
I95.0 Idiopathic hypotension
I95.1 Orthostatic hypotension
I95.2 Hypotension due to drugs
I95.9 Hypotension, unspecified
K29.00 Acute gastritis without bleeding
K29.01 Acute gastritis with bleeding
K29.20 Alcoholic gastritis without bleeding
K29.21 Alcoholic gastritis with bleeding
K29.30 Chronic superficial gastritis without bleeding
K29.31 Chronic superficial gastritis with bleeding
K29.40 Chronic atrophic gastritis without bleeding
K29.41 Chronic atrophic gastritis with bleeding
K29.50 Unspecified chronic gastritis without bleeding
K29.51 Unspecified chronic gastritis with bleeding
K29.60 Other gastritis without bleeding
K29.61 Other gastritis with bleeding
K29.70 Gastritis, unspecified, without bleeding
K29.71 Gastritis, unspecified, with bleeding
K29.80 Duodenitis without bleeding
K29.81 Duodenitis with bleeding
K29.90 Gastroduodenitis, unspecified, without bleeding
K29.91 Gastroduodenitis, unspecified, with bleeding
K52.21 Food protein-induced enterocolitis syndrome
K52.22 Food protein-induced enteropathy
K52.29 Other allergic and dietetic gastroenteritis and colitis
K52.3 Indeterminate colitis
K52.81 Eosinophilic gastritis or gastroenteritis
K52.831 Collagenous colitis
K52.832 Lymphocytic colitis
K52.838 Other microscopic colitis
K52.839 Microscopic colitis, unspecified
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
K92.0 Hematemesis
M62.82 Rhabdomyolysis
O21.1 Hyperemesis gravidarum with metabolic disturbance
O21.2 Late vomiting of pregnancy
O21.8 Other vomiting complicating pregnancy
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 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
Z51.12 Encounter for antineoplastic immunotherapy
Z51.89* Encounter for other specified aftercare
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Z51.89 should be reported for chemotherapy and immunotherapy aftercare.

Group 2

(4 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Report an encounter for radio-contrast dye(s), when hydration is needed in conjunction with angiography or CT scan with contrast, with the primary diagnosis of Z92.89 (personal history of other medical treatment) and one of the secondary diagnoses from the list below.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070, J7120 and J7121:

Group 2 Codes
Code Description
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital - Swing Beds
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
028x Skilled Nursing - Swing Beds
071x Clinic - Rural Health
077x Clinic - Federally Qualified Health Center (FQHC)
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.


Code Description
0250 Pharmacy - General Classification
0258 Pharmacy - IV Solutions
0260 IV Therapy - General Classification
0263 IV Therapy - IV Therapy/Drug/Supply/ Delivery
045X Emergency Room - General Classification
076X Specialty Services - General Classification
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
03/31/2023 R6

This article is being retired effective for dates of service on and after 03/01/2023.

12/10/2021 R5

Article revised and published on 02/17/2022 effective for dates of service on and after 12/10/2021 in response to an inquiry.

The following ICD-10 code has been added to ICD-10-CM Codes Group 1 section in the Article: Z51.12. Also, the Asterisk Explanation statement was revised to read *Z51.89 should be reported for chemotherapy and immunotherapy aftercare.

01/05/2021 R4

Article revised and published on 3/11/2021 effective for dates of service on and after 01/5/2021 in response to an inquiry.

The following ICD-10 codes have been added to the Article: I95.0 & I95.2.

12/10/2020 R3

Article revised and published on 12/10/2020 effective for dates of service on and after 09/11/2020 to reflect the addition of ICD-10-CM code I95.1 to the Group 1 codes.

10/01/2020 R2

Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10 codes have been added to the article: D57.03, D57.09, D57.213, D57.218, D57.413, D57.418, D57.431, D57.432, D57.433, D57.438, D57.451, D57.452, D57.453, D57.458, D57.813 and D57.818 for Group 1 Codes and N18.31 and N18.32 for Group 2 Codes. The following ICD-10 code has been deleted and therefore has been removed from the article for Group 2 Codes: N18.3. The following ICD-10 codes have undergone a descriptor change for Group 1 Codes: D57.411, D57.412, and D57.419. Minor formatting has been made throughout the coding section.

07/19/2019 R1

LCD revisied and published on 10/17/2019 effecive for dates of service on or after 07/19/2019 to add ICD-10-CM codes D57.00, D57.01, D57.02, D57.211, D57.212, D57.219, D57.411, D57.412, D57.419, D57.811, D57.812 and D57.819 to the Group 1 Codes. System changes have been made to our articles in response to CMS Change Request 10901. The Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34960 - Hydration Therapy
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
03/31/2023 12/10/2021 - 03/01/2023 Retired You are here
02/11/2022 12/10/2021 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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