How To Use CPT Code 96361

CPT 96361 refers to the administration of intravenous hydration for each additional hour beyond the initial hour, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 96361?

CPT 96361 is a medical billing code used to describe the administration of intravenous (IV) hydration for each additional hour beyond the initial hour. This code is used when a patient requires more than one hour of IV hydration, and it is billed in addition to the primary procedure code. Medical professionals use this code to ensure proper reimbursement for the extended time spent administering IV hydration to patients.

2. 96361 CPT code description

The official description of CPT code 96361 is: “Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)”.

3. Procedure

1. The provider discusses the need for additional hydration infusion with the patient or a family member, explaining why it is necessary and what to expect.
2. The provider compares the label on the bag of fluid and electrolytes to the orders for the infusion and hangs the prepackaged bag of fluid with electrolytes on the IV pole, connecting it to the tubing for the IV.
3. The provider starts the infusion through an already established IV site.
4. Additional fluids are administered for as many hours as required for adequate hydration.

4. Qualifying circumstances

Patients eligible to receive CPT code 96361 services are those who require more than one hour of IV hydration due to severe dehydration or other medical conditions that necessitate extended IV fluid administration. The provider must have already billed for the initial hour of IV hydration using the primary code 96360 before adding CPT 96361 for each additional hour.

5. When to use CPT code 96361

It is appropriate to bill the 96361 CPT code when a patient requires more than one hour of IV hydration, and the total IV infusion time reaches 91 or more minutes. The provider must have already billed for the initial hour of IV hydration using the primary code 96360 before adding CPT 96361 for each additional hour.

6. Documentation requirements

To support a claim for CPT 96361, the provider or nurse should clearly document the start and stop times for each bag, the route of administration, and whether a flush or hydration is performed. If only a flush or clearing of lines occurs, the procedure should not be coded unless the flush occurs with medication, known as an IV push. An IV push can be coded.

7. Billing guidelines

When billing for CPT code 96361, it is essential to follow specific guidelines and rules. First, ensure that the primary code 96360 has been billed for the initial hour of IV hydration. Next, use CPT 96361 for each additional hour of IV fluid hydration in addition to the primary procedure code. No modifier is needed for 96361. Do not report 96361 if hydration is performed in conjunction with therapeutic infusion. You can charge for hydration before or after a therapeutic infusion, but do not count the time for the hydration running at the same time as the therapeutic infusion.

8. Historical information

CPT 96361 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition.

9. Similar codes to CPT 96361

Five similar codes to CPT 96361 and how they differentiate are:

• CPT 96360: This code is used for the initial hour of IV hydration, whereas CPT 96361 is used for each additional hour.
• CPT 96365: This code is for the initial hour of a therapeutic, prophylactic, or diagnostic IV infusion, while CPT 96361 is for additional hours of IV hydration.
• CPT 96374: This code is for an IV push rather than an IV infusion, unlike CPT 96361, which is for additional hours of IV hydration infusion.
• CPT 96409: This code is for the administration of chemotherapy, while CPT 96361 is for additional hours of IV hydration.
• CPT 96413: This code is for the initial hour of chemotherapy infusion, while CPT 96361 is for additional hours of IV hydration.

10. Examples

1. A patient with severe dehydration requires three hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional two hours.
2. A patient undergoing chemotherapy requires two hours of IV hydration before treatment. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional hour.
3. A patient with a gastrointestinal illness requires four hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional three hours.
4. A patient with kidney failure requires two hours of IV hydration after a dialysis session. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional hour.
5. A patient with a high fever requires three hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional two hours.
6. A patient with a severe electrolyte imbalance requires five hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional four hours.
7. A patient with a severe infection requires six hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional five hours.
8. A patient with a severe burn requires four hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional three hours.
9. A patient with a severe allergic reaction requires two hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional hour.
10. A patient with a severe blood loss requires three hours of IV hydration. The provider bills CPT 96360 for the initial hour and CPT 96361 for the additional two hours.