Penelope Posted Wed 01st of February, 2012 21:01:16 PM
Can Venofer infusion (96365 & J1756) be billed with saline (96361 & J7050) in an office setting providing the start and end time is documented? Or is the saline considered inculsive and not billed separately?
Will appreciate any guidance or coding references.
SuperCoder Answered Thu 09th of February, 2012 15:42:58 PM
Coding hydration with therapeutic infusion is a tricky area.
Medicare’s Correct Coding Initiative (CCI) policy manual states, “Hydration concurrent with other drug administration services is not separately reportable” (chapter 11, section B.5).
You also shouldn’t code the saline if it runs just to keep the line open, according to CPT guidelines. The guidelines also state not to report hydration if it runs 30 minutes or less.
On the other hand, you may report hydration that has been ordered and has documentation of medical necessity. Also remember it needs to run 31 minutes or more, and you can’t count it if it’s running concurrent with a therapeutic infusion.
To avoid confusion and promote documentation quality, ask physicians to document their clinical rationale when they include hydration as part of the medication therapy order.