Health Information Management

Q/A: Volume requirement for reporting hydration services

APCs Insider, May 25, 2012

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Q: Can we report a bolus of less than 500 cc of fluid as a hydration service if the infusion meets the greater than 30 minute requirement defined by CPT®?

A: This question used to be a specific “yes” as long as there was a complete physician order (including valid authentication) along with documentation to support the medical necessity and the time requirement for reporting the CPT code. However, Trailblazer and Cahaba, two FI/MACS recently published Local Coverage Determinations (LCD) regarding hydration services. The LCDs state that infusion of 500 cc or less is not reportable as hydration service as the volume is not sufficient to support rehydration of the patient.

Both Trailblazer and Cahaba have published LCDs that state that “rehydration with the administration of an amount of fluid equal to or less than 500ml is not reasonable and necessary.” In addition, both note that hanging fluid “just prior” to chemotherapy is not considered hydration therapy.  Documentation to support medical necessity and the documentation related to the time of infusions is critical to support the service being reported.

Each facility should check both the active and draft LCDs for their FI/MAC to see what is current and what is coming. Facilities can comment on these documents, but often don’t monitor the documents still in the draft phase. If providers don’t comment, the LCDs (and National Coverage Determinations) go into effect without any provider input.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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