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Basics of Hydration CPT code 96360 & 96361

Hydration is defined as the replacement of necessary fluids via an IV infusion which consists of pre-packaged fluids and electrolytes. Hydration services are reported by using CPT codes 96360 (initial 31 minutes to 1 hour) and 96361 (each additional hour). IV fluids reported for hydration lasting 30 minutes or less is not reported using infusion codes.

Some chemotherapeutic agents and other therapeutic agents require pre- and/or post-hydration to be given in order to avoid specific toxicities. A minimum time duration of 31 minutes of hydration infusion is required to report the service. However, the hydration CPT code 96360 or 96361 are not used when the purpose of the intravenous fluid is to “keep open” an IV line prior or subsequent to a therapeutic infusion, or as a free-flowing IV during chemotherapy or other therapeutic infusion

96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour

96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)

Factors to consider when choosing appropriate CPT code selection:

Reason for encounter
Other infusion/injection services provided at same encounter
Medical necessity of fluid administration
Length of infusion time
Type of infusion and treatment provided

A physician or an assistant under direct physician supervision infuses a hydration solution (prepackaged fluid and electrolytes) for 31 minutes to one hour through an intravenous catheter inserted by needle into a patient’s vein or by infusion through an existing indwelling intravascular access catheter or port. Report CPT code 96361 for each additional hour beyond the first hour. Intravenous infusion for hydration lasting 30 minutes or less is not reported.

To learn more about injection procedure codes, you can refer the below links

Spinal Injection Procedure codes for Medical coders

When to use Sentinal injection CPT code 38792 and lymphoscintigraphy code 78195

Coding guide for Epidural infusion, Catheter and Pump implantation CPT codes

Difference between Infusion, Injection and Hydration

• Infusion: involves the administration of IV fluids and/or drugs over a period of time for diagnostic or therapeutic purposes.

• Injection: delivers a dosage in one ‘shot,’ either very quickly or in some cases over a period of time where the healthcare provider is continuously present to administer the injection either subcutaneously, intramuscularly, intra-arterially, or intravenously.

• Chemotherapy: the use of medicine or drugs to treat cancer delivered by various routes of administration. The CPT Manual also includes other highly complex drugs and highly complex biological agents in this category.

• Nonchemotherapy: includes therapeutic, prophylactic, and diagnostic medicines and drugs delivered by a variety of routes.

• Hydration: solution may include a combination of sugar and carbohydrates (for energy), electrolytes, and trace elements delivered by infusion (hanging a bag with fluids).

Understand the Hierarchy

The ED coders should follow the hierarchy 96365>96374>96372>96360. The CPT codes for IV infusion, IV pushes, IV injection and hydration should be based on this hierarchy.

The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services, which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy is to be followed by facilities and supersedes parenthetical instructions for add-on codes that suggest an add-on code of a higher hierarchical position may be reported in conjunction with a base code of a lower position.

Infusion involves an IV medication given over 15 minutes or more
Injection (or Push) involves medication given over less than 15 minutes
Hydration involves prepacked fluids given through an IV (such as normal saline, potassium chloride in dextrose, sodium chloride etc.) over the course of 31 minutes to one hour.

When to use Hydration CPT code 96360 and 96361

The hydration codes 96360 and 96361 were developed to report specific therapeutic interventions undertaken when a patient presents with dehydration and volume loss requiring clinically necessary intravenous fluid. The necessity for hydration should be documented in the record.

The primary example is a patient who presents with dehydration and volume loss and requires rehydration. Codes 96360 and 96361 are intended to report intravenous infusions of prepackaged fluid with or without electrolytes but are not used to report infusion of drugs or other substances.

We are frequently asked to clarify what constitutes “prepackaged fluid with or without electrolytes” and how to differentiate and when to use the therapeutic infusion code(s). To illustrate, the following example is provided:

Example: A 33-year-old patient receives 79 minutes of an intravenous (IV) normal saline infusion for dehydration.

How to Code: Because no other IV infusion service was provided that day, this is an initial service (only hydration) reported using code 96360. The normal saline infusion did not include any electrolyte. Note the type of intravenous fluid administered to treat the dehydration is prepackaged but without any added electrolyte(s). In this instance the reason for the infusion is hydration, hence the use of code(s) 96360, 96361 as opposed to the therapeutic infusion codes.