Radiology Question for the Week of March 7, 2016

Question:

We are doing more and more intravenous (IV) hydration in our department. Typically, we infuse fluids for one hour prior and one hour post a computed tomography (CT) or magnetic resonance imaging (MRI) study with contrast. Can we charge for this, and can we include charges for the IV fluids also? What are the actual codes that can be assigned for this?

Answer:

Before you do anything, verify how the order is written for the fluid administration. Has the medical intent of hydration therapy been met? Is this routinely done or medically necessary? If the fluid administration is protocol-based on contrast administration, it is likely considered inherent in the CT procedure.

In jurisdictions where a published coverage determination exists for hydration therapy, you probably will find a limitation of coverage that requires assignment of the diagnosis code Z92.89 (personal history of other medical treatment [elevated lab values for BUN/Creat and GFR]) with a secondary diagnosis of renal failure documented as level 3 (moderate), 4 (severe) or 5 (end stage). 

If medically necessary and ordered, hydration (96360-59) may be coded; however, the documentation should be very clear that this is a separate medically necessary service and not routine administration of fluids. Do not code 96360 for keeping a line open. 

The NCCI Policy Manual for Medicare Services includes the following guideline: 

1.            If a radiologic procedure requires that contrast be administered orally (e.g., upper GI series) or rectally (e.g., barium enema), the administration is integral to the radiologic procedure, and the administration service is not separately reportable. If a radiologic procedure requires that contrast material be administered parenterally (e.g., IVP, CT, MRI), the vascular access (e.g., CPT codes 36000, 36406, 36410) and contrast administration (e.g., CPT codes 96360–96376) are integral to the procedure [the contrast material administration] and are not separately reportable.

Typically, IV fluids such as saline have Level ll J-codes that may be appropriate to submit. The J-code would be based upon the material(s) that you provide.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.