Hydration (96361) vs IV Start (96365)

Hello,

21:51 11/12/2014 Site #1 started via IV in the right antecubital space with an 20g angiocath, with aseptic technique and good blood return; one attempt. Blood drawn: rainbow set.

22:00 11/12/2014 Zofran IVP 4 mg given over 4 minute(s) via site #1. Allergies verified and confirmed 5 rights. IV patency established. IV site checked: no pain, redness, or swelling. IV flushed thoroughly pre- and post-medication administration. IVP given by RN.

22:05 11/12/2014 Morphine IVP 4 mg given over 4 minute(s) via site #1. Allergies verified and confirmed 5 rights. IV patency established. IV site checked: no pain, redness, or swelling. IV flushed thoroughly pre- and post-medication administration.

23:33 11/12/2014 Started IV Fluids NS ; Initial bolus of 750 mL then 1000 mL/hr over 30 minute(s) via site #1 via IV pump. Allergies verified and confirmed 5 rights. IV patency established. IV site checked: no pain, redness, or swelling. IV flushed thoroughly pre- and

post-medication administration.

00:49 11/13/2014 IV Fluids NS Discontinued: bag #1 STOPPED upon discharge. Total amount infused: 800. IV patency established. IV site checked: no pain, redness, or swelling.

IV flushed thoroughly.

I coded this as

96374

96375

96361

But am being told to bill as

96374

96375

96365

96366

Should it be

96365

96375

96375

or not bill hydration at all?

dx:

Atypical chest pain

Renal insufficiency

This is what I was told: , you've been entering cpt code 96360 or 96361 which is IV Hydration. It should be 96365 which is IV start infusion for therapy, prophylaxis or diagnosis. This is used when you are starting an IV and also infusing medications. IV Hydration is ONLY used when the patient presents with Nausea vomiting, diarrhea, emesis, etc and we are only hydrating the patient not giving meds or any other type of treatment.

So then I asked another coder, and she didn't agree with the 96365 but said she wouldn't have been billed the 96361 at all since it is not medically necessary and the patient wasn't dehydrated (N/V, diarrhea, emesis).

I don't understand. I thought a drug had to be used with 96365. The way I was trained and information I can find, you would not bill 96365 for the start of hydration.

Is the hydration in the above case considered infusion for therapeutic, prophylactic (preventive), or diagnostic medication?

Any help would be greatly appreciated! Thanks in Advance

Hydration (96361) vs IV Start (96365)