Non-Chemo IV Drug & Hydration Coding — Step-by-Step
First, confirm documentation
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Route, drug/substance, start & stop times for each infusion, and each push given.
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IV access site(s) used (one site vs. two distinct sites).
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Clinical reason for hydration (not just KVO).
Pick the initial code using the hierarchy (per encounter, per IV site)
Hierarchy (highest → lowest):
Therapeutic infusion (96365) → Injection/IV push (96374) → Hydration (96360).
(Infusion services outrank injections, which outrank hydration.)
Multiple “initials”?
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Yes, if separate IV sites are medically necessary. You may bill a second initial for the second site (append payer-required modifier like -59/XE to the second initial).
Decide infusion vs. IV push (the 15-minute rule)
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If the drug ran ≤ 15 minutes, code as IV push (96374/96375/96376).
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Infusion codes require > 15 minutes; hydration initial requires ≥ 31 minutes.
Time rules & add-ons
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96365 (therapeutic infusion, initial) = up to 1 hr (must be ≥ 16 min).
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+96366 = each additional hour when time is > 30 min beyond a full hour (e.g., 1:31–2:30 = one unit).
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96360 (hydration initial) = 31–60 min; +96361 = each additional hour > 30 min beyond the hour.
Sequential vs. concurrent vs. overlapping hydration
Sequential (one after another, same access):
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New substance/drug after the initial infusion: +96367 (up to 1 hr) and +96366 for extra time if >30 min beyond the hour.
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New IV push after the initial push/infusion: +96375 (new substance); +96376 for repeat push of the same drug in a facility ≥ 30 min after the prior push.
Concurrent (two infusions running at the same time through the same access):
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Report +96368 once per encounter (not time-based).
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Not for hydration (hydration has no concurrent code).
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Mixing multiple drugs in one bag counts as one infusion, not concurrent.
Overlapping hydration:
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Do not bill hydration time that overlaps with any other reportable infusion/administration on the same IV access (not separately payable).
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Hydration before or after other services may be billed if medically necessary and time thresholds are met.
Hydration “gotchas”
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Must be medically necessary (e.g., dehydration, nephro-protection), not KVO.
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Minimum 31 minutes to report 96360.
Common code set (non-chemo)
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96365 Initial IV infusion, therapy/prophylaxis/diagnosis, up to 1 hr → add +96366 per additional hr (>30 min).
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+96367 Additional sequential infusion (new substance), up to 1 hr.
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+96368 Concurrent infusion (once per encounter).
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96374 IV push, single/initial substance; +96375 each additional new substance by IV push; +96376 repeat push of the same drug in facility setting (≥30 min later).
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96360 Initial hydration, 31–60 min; +96361 each additional hr (>30 min)
Mini decision pathway
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List each IV site used. If >1 site, you may have >1 initial (one per site).
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For each site, pick the initial by hierarchy (Therapeutic infusion → IV push → Hydration).
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For each service, apply time thresholds (infusion >15 min; hydration ≥31 min; add-ons >30 min beyond the hour).
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Add sequential (+96367/+96366; +96375/+96376) or concurrent (+96368 once) as applicable. No concurrent hydration.
Worked examples
Two IV sites, both medically necessary
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Site A: Zosyn infusion 1 hr 20 min → 96365 (initial) + no 96366 (not >30 min beyond 1st hr).
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Site B: Morphine IV push once → 96374 (second initial on different IV site; append -59/XE per payer).
Hydration before & after a drug infusion (no overlap)
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Hydration pre 40 min → 96360.
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Ceftriaxone infusion 1 hr 35 min → 96365 + +96366 (extra time >30 min).
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Hydration post 50 min → +96361.
(Do not bill any hydration time that overlaps with the ceftriaxone infusion.)
Concurrent infusions
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Vancomycin runs 1 hr (initial), Piperacillin-tazobactam overlaps for 45 min through the same line → 96365 + +96368 once (concurrent is not time-based; only once per encounter).
“Short” infusion
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Ketorolac runs 14 min → code as IV push 96374 (≤15 min → push).
Repeat push of the same drug
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Metoclopramide IV push at 10:00 and again at 10:40 in the ED → 96374 (initial) + +96376 (repeat push of same drug in facility, ≥30 min later).
Quick pitfalls to avoid
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Counting overlapping hydration time with any other infusion (not allowed).
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Using concurrent codes per hour (they’re once per encounter).
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Calling multiple drugs in one bag “concurrent” (it’s one infusion, not concurrent).
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Missing start/stop times—you can’t support add-on hours without them.
Keep at hand (code families)
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Infusion (non-chemo): 96365, +96366, +96367, +96368.
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Push (non-chemo): 96374, +96375, +96376.
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Hydration: 96360, +96361.
If you want, I can turn this into a one-page printable PDF flowchart for your team.
Centers for Medicare & Medicaid Services
Download the PDF in the Coding Clarified Medical Coding groups on Facebook: Medical Coding “Clarified” & Medical Coding for Newbies