Health Information Management

Q/A: Calcium gluconate administration: Infusion or hydration?

APCs Weekly Monitor, October 30, 2009

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Q. A patient who has undergone a kidney transplant and has plasmapheresis intravenously receives IV immune globulin (IVIG) and calcium gluconate. The calcium gluconate consists of 3000 mg in 250ml of normal saline.
 
Should we code the administration of the calcium gluconate as a therapeutic infusion or as hydration?
 
A. Bill the calcium gluconate administration as a therapeutic infusion, not as hydration. According to the 2009 CPT Manual, codes 96360–96361 “are intended to report a hydration IV infusion to consist of prepackaged fluid and electrolytes (e.g., normal saline, D5-1/2 normal saline +30mEq/liter), but are not used to report infusion of drugs or other substances.”
 
Calcium gluconate is considered an electrolyte in the treatment of hypocalcemia in conditions requiring a prompt increase in plasma calcium. This is not usually a prepackaged solution, so it would not qualify as hydration, according to CPT Manual instructions. 
 
Assuming that the calcium gluconate is started first, the appropriate 2009 CPT code for the infusion of calcium gluconate is 96365 for the first hour and 96366 for each additional hour. Code the second infusion (IVIG), if administered through the same IV site, with 96367 (sequential infusion) or 96368 (concurrent infusion) based on documentation in the record.



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