Cardiology Question for the Week of July 24, 2017

Question:

Can the department charge for pre- and post-TAVR (transcatheter aortic valve replacement) hydration using CPT^® 96360 and 96361? The patient sometimes received two hours of pre-hydration and three hours of post-hydration before and after the TAVR scan.

Answer:

First, you must 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 administration of the fluid is protocol, based on contrast administration, it is likely considered inherent in the CT procedure and should not be separately billed.

When documentation supports the need for hydration due to nephrotoxicity, then there needs to be sufficient documentation of reduced glomerular filtration to support the increased potential of toxicity. In jurisdictions where a published coverage determination exists for hydration therapy, you would likely find limitation of coverage requiring a diagnosis of elevated lab values for BUN/creatinine 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.

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