Intravenous (IV) Infusions

Introduction:
This document aims to understand the physiology behind intravenous infusions and how
we can submit claims or charges based on time infused. Intravenous (IV) infusions are billed
based on the CPT/HCPCS description of the service rendered. A provider may bill for the total
time of the infusion using the appropriate add-on codes (CPT/HCPCS for each additional unit of
time)

Type/Methods of Injections
 Intramuscular (90O)
 Subcutaneous (45O)
 Intravenous (25O)
 Intradermal (10-15O)

Basic Understanding
Having an intravenous (IV) infusion or
“drip” means you can have fluid or medicine straight into your veins rather than having to
swallow it. A drip uses a cannula (Narrow, bendy tube) put into a vein in the back of your hand
or lower arm. Occasionally, someone might need to have a cannula in a vein in their foot but
this doesn’t happen very often.
 Initial Services
Only one initial code is allowed per patient encounter unless two separate IV sites
are medically reasonable and necessary.
o If the patient returns for a separate, medically reasonable, and necessary
visit/encounter on the same day, another initial code may be billed with
modifier 59
o If the patient encounters two separate IV sites on the same visit, 2 initial
codes can be billed with modifier 59 unless it is medically reasonable and
necessary (or XE).
o Same site, only one initial code is allowed per patient per encounter per
day.
o Example CPT Codes:
 96374 – Therapeutic, Prophylaxis or Diagnosis
 96365 – IV Infusion, for therapy, prophylaxis or diagnostic
  96360 – IV Hydration
 96409 – Chemotherapy – Intramuscular
 96413 – Chemotherapy
 Time Documentation
o IV is based on drug administration codes and they are time-dependent.
The Qualified Healthcare Professional (QHP) should document the start and
stop times for infusions. The documentation required as
 Date of service
 Medication names
 Dose
 Route of administration
 Infusion start and stop time

How to Bill Claims

The billing for IV has been done with three types
 Initial Service
o IV hydration was performed only then it will be billed 96360 for the initial
31 to 90 min (1 Hour) and 96361 for an additional hour 91-150 and so on
151-210.
o IV push or Therapeutic infusions with hydration is always reported with
initial hour code 96374 for 16-90 min.
o Following that code 96361 must be assigned for the hydration.

Hours Therapeutic or IV Push CPT Hydration CPT

 1st 16-90 min 96374 30-91 min 96360
2nd 91-150 min 96361 91-150 min 96361
3rd 151-210 min 151-210 min
 Sequential Administration
o Sequential administration is applied when multiple drugs are infused “back
to back” or one after the other.
o It must be a different drug through the same IV access
o 96367(additional sequential infusion) – report once per drug
 If additional hours of infusion, report 96366
 Concurrent Administration
o Concurrent is when multiple therapeutic or diagnostic medications (not
hydration fluids) are infused simultaneously through separate bags through
the same IV line
o 96368 (concurrent infusion) – report once per date of service
 If additional hours of infusion, report 96366
1. What is Hydration
 96360
 96361
Hydration is defined as the replacement of necessary fluids via an IV infusion which
consists of pre-packaged fluid and electrolytes. Some of the solutions utilized in the
administration of hydration services are:
 Saline solutions
 Dextrose 5% water D5W, Distilled water etc..
 Medical Necessity must be met as abnormal fluid losses, abnormal vital signs,
abnormal laboratory studies, etc..
Billing
 96360 is for the initial service of hydration when hydration is the only service performed
o A minimum of 31 minutes of hydration is required to report. Below 30 minutes
would not be reportable
 96361 in conjunction with CPT 96360
o So basically after an hour every 31st minute will be counted in the CPT 96361
o >30 min = 96360
o >91 min = 96361 – 1 unit
o > 151 min = 96361 – 2 units
 Report 96361 as a subsequent service after different initial services (96360,
96365, 96374, 96409, 96413) is administered through the same IV access.
Example 1:
A patient is seen at our facility because of dehydration due to continuous nausea with vomiting.
She is given a prepackaged solution of 1,000 cc's of normal saline with potassium added to the
bag which was prepared by the pharmacy. The hydration is administered for an hour and 15
minutes.
Answer 1:
CPT code 96360, Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Explanation
There was no other intravenous infusion service performed during this encounter and the
primary reason was to administer the fluids. The additional 15 minutes would not be reported
due to hydration services not being greater than 30 minutes past the initial hour.

Example 2:
A 55 year-old diabetic female is brought to the emergency department due to acute altered
level of consciousness. Blood glucose level initially is 42 mg1dL. The patient is promptly
administered dextrose 50% (D50) 25g IV push for the altered level of consciousness at 08:29
am. Her blood glucose at 08:37 is 219 mgl dL. What is the correct CPT code for the D50?
Answer 2:
No Code for the administration of Hydration because 30 minutes or less is not reportable.

2. Infusion
 96365 (Initial Code
 96366 (add-on code) – Conjunction Codes 96365 or 96367
 96367 (add-on code) – Conjunction Codes 96374, 96409 96413
 96368 (add-on code) – Conjunction Codes 96365, 96366, 94613, 96415,
96416
 96374 (Initial Code)
 96375 (add-on code)
 96376 (add-on code)
Example 3:
A patient with a diagnosis of bacterial enteritis and dehydration is admitted to the outpatient
department with orders for infusion of IV Levaquin over two hours. Also has orders for
Demerol and Reglan IV push. After the above medications were infused, Nursing contacted
the physician due to patients low blood pressure and lack of urine output. MD orders three
hours of intravenous fluids of Ringer’s lactate for documented dehydration

Coding 3:
 96365 – IV Levaquin for 1 hour
 96366 – IV Levaquin for Additional hour
 96375 – Demerol (Sequential Administration)
 96375 – Reglan (Sequential Administration)
 96361 – Additional Hour for Hydration Ringer
 96361 – Additional Hour for Hydration Ringer
 96361 – Additional Hour for Hydration Ringer

Example 4:
The patient arrived in the emergency department and received an intravenous hydration
infusion with Vancomycin for over 1 hour. How would the hydration and administration of
Vancomycin be reported?

Coding 4:
 96365 – Intravenous infusion, for therapy, prophylaxis, or diagnosis; (specify substance
or drug) initial, up to 1 hour, for the service provided. This hydration service would be
considered integral to the drug administration and not separately reported

Example 5:
A patient was seen at our facility for low potassium level. He received 1 hour of intravenous
hydration fluid mixed with potassium for treatment of the patient's low potassium level.
What would the correct CPT code be for this encounter?

Coding 5:
  96365 – Intravenous infusion, for therapy, prophylaxis, or diagnosis; (specify substance
or drug) initial, up to 1 hour, for the service provided.
Example 6:
A patient with Congestive Heart Failure with given an IV bolus of Amiodarone at 0700. At
0800, an infusion of Lasix was started and ended at 1020.

Coding 6:
 96365 – For IV bolus of Amiodarone, initial hour
 96375 – For Sequential push IV
 96366 – for an additional hour

Key Ranges

Time Coding Category

00 – 15 min IV Push
15 – 30 min Infusion
31 – 91 min Hydration

Infusion/Injection Codes – Chemotherapy

Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of
a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent or it
may aim to prolong life or to reduce symptoms. It uses powerful chemicals to kill fast-growing
cells in your body
Services Include:
 Chemo initiation of prolonged infusion? 8 hours requiring pump
 Chemo infusions
 Chemo injections

CPT Code Description Time Duration

96413 Chemotherapy admin, intravenous infusion 16 - 60 min
technique, up to 1 hour, single or initial
substance drug
96415 (add-on) Each additional Hour 61 > min, must be greater
than 30 min 1 min after 1
hour beyond
96417 Each Sequential infusion (different 16 - 60 min
substance/drug)
96418 Concurrent infusion (Once per Day) 16 – 1 hour, Report only
once per encounter

Summary
 Review the Excel Files