How To Use CPT Code 96360

CPT 96360 refers to the initial intravenous (IV) hydration infusion procedure for 31 minutes to 1 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 96360?

CPT 96360 is a medical billing code used to describe the initial intravenous (IV) hydration infusion procedure for 31 minutes to 1 hour. This code is utilized by medical professionals to accurately document and bill for the specific service provided to patients who require IV hydration infusion for various medical reasons.

2. 96360 CPT code description

The official description of CPT code 96360 is: Intravenous infusion, hydration; initial, 31 minutes to 1 hour.

3. Procedure

1. The provider discusses the need for hydration with the patient and/or a family member, explaining why it is necessary and what to expect.
2. The provider inserts the stylet, or needle, of the catheter directly into a patient’s vein in the hand or arm. In very young patients, the provider may choose a vein in the foot. The provider may use an existing indwelling intravascular access catheter or port.
3. He compares the label on the bag of fluid and electrolytes to the orders for the infusion.
4. The provider then establishes the IV site and starts infusion of the initial hydration solution, a prepackaged fluid with electrolytes.
5. Use this code for the initial 31 minutes to one hour of intravenous hydration.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 96360 services are those who require intravenous hydration infusion due to severe dehydration, electrolyte imbalances, or other medical conditions that necessitate the need for IV fluid administration. The provider must determine the medical necessity for the hydration infusion and ensure that the patient meets the appropriate criteria for this service.

5. When to use CPT code 96360

It is appropriate to bill the 96360 CPT code when the provider performs an initial intravenous hydration infusion for a duration of 31 minutes to 1 hour. This code should not be used for hydration infusions lasting 30 minutes or less or for concurrent infusion services.

6. Documentation requirements

To support a claim for CPT 96360, the following information must be documented in the patient’s medical record:

• Medical necessity for the hydration infusion
• Start and stop times for the infusion
• Route of administration
• Type of fluid and electrolytes used
• Any complications or adverse reactions during the infusion

7. Billing guidelines

When billing for CPT code 96360, it is essential to follow specific guidelines and rules to ensure accurate reimbursement. Some tips and codes that apply to CPT code 96360 include:

• Append modifier 76 for each additional infusion of the same substance or drug.
• Append modifier 59 when the initial and the second infusion do not last more than 31 minutes each.
• Use add-on code 96361 for IV hydration infusion lasting more than one hour.
• Do not report 96360 with initial IV push 96374 or add-on code 96375 unless protocol requires two separate IV sites.

8. Historical information

CPT 96360 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 96360

Five similar codes to CPT 96360 and how they differentiate from CPT 96360 are:

• CPT 96361: This add-on code is used for each additional hour of intravenous hydration infusion.
• CPT 96365: This code is for the initial hour of intravenous infusion for therapy, prophylaxis, or diagnosis.
• CPT 96366: This add-on code is for each additional hour of intravenous infusion for therapy, prophylaxis, or diagnosis.
• CPT 96374: This code is for therapeutic, prophylactic, or diagnostic injection via intravenous push.
• CPT 96375: This add-on code is for each additional sequential intravenous push of a new substance or drug.

10. Examples

Here are 10 detailed examples of CPT code 96360 procedures:

1. A patient with severe dehydration due to gastroenteritis receives an initial IV hydration infusion for 45 minutes.
2. A patient with electrolyte imbalance caused by kidney disease undergoes an initial IV hydration infusion for 1 hour.
3. An elderly patient with dehydration due to inadequate fluid intake receives an initial IV hydration infusion for 35 minutes.
4. A patient with heat exhaustion and dehydration undergoes an initial IV hydration infusion for 50 minutes.
5. A patient with diabetic ketoacidosis receives an initial IV hydration infusion for 40 minutes to correct fluid and electrolyte imbalances.
6. A patient with severe vomiting and dehydration due to food poisoning undergoes an initial IV hydration infusion for 55 minutes.
7. A patient with dehydration and electrolyte imbalance caused by excessive alcohol consumption receives an initial IV hydration infusion for 31 minutes.
8. A patient with dehydration due to excessive sweating from a high fever undergoes an initial IV hydration infusion for 45 minutes.
9. A patient with dehydration and electrolyte imbalance caused by severe diarrhea receives an initial IV hydration infusion for 1 hour.
10. A patient with dehydration due to inadequate fluid intake following surgery undergoes an initial IV hydration infusion for 35 minutes.