Health Information Management

Q/A: Hydration services continuing past midnight

APCs Weekly Monitor, June 26, 2009

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Q: How should we report hydration services that run past midnight into the next calendar day along with other drug administration services on a UB04 claim form?
 
For example: on 5/5/09 IVP provided for Zofran and an order for NS at 200 ml per hour began at 23:48 and completed the following calendar day 5/6/09 at 1:30 am.
 
A: Based on your question, the dates of service 5/5 through 5/6 would be considered one outpatient encounter crossing a calendar day. Always keep the facility drug hierarchy in mind. Regardless of when the services were provided, IVP of Zofran (96374) would be the initial service provided on 5/5 followed by the hydration (96361) provided on 5/5 and 5/6, reported on 5/5 with 2 units.
 
The UB04 claim requires from and through dates, so Field Locator (FL) 6 will report 5/5 through 5/6, which will open the Outpatient Code Editor (OCE) to identify the claims as one encounter with multiple dates for HCPCS codes.
 
Review your internal claims scrubber. Some vendors have created priority edits for their clients that cause claims to suspend, especially with drug administration services that cross calendar days, thereby seemingly requiring an initial drug administration service for each date. Facilities should not reset the drug hierarchy rules per calendar day for outpatient encounters.
 

Also, CMS stated during its January 2007 CMS Open Door Forum (ODF) conference call that “multiple initial services should not be reported for a single encounter, even if the encounter crosses dates of service. Do not ‘reset’ the initial definition each calendar day.”



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