Cracking the Code

IV Hydration Guidance

When a patient enters the emergency department (ED), an intravenous (IV) site full of pre-packaged fluids and electrolytes is typically started for the purpose of providing hydration. Hydration is basically the replacement of necessary fluids. As a medical coder, it is very important to have a firm understanding of when to report and how to accurately report hydration procedures. Some of the solutions that are administered for hydration are saline solutions, dextrose 5% water (D5W), hypotonic solution, ringer lactate, and distilled water (DW).

In order to properly report hydration procedures, it is important to have a firm understanding of when and how to report them. Hydration services are NOT reportable when the fluid is used to flush an IV line prior or subsequent to another infusion; when the fluid is used as the diluent to mix the drug; and when the hydration’s purpose is to accommodate a therapeutic IV piggyback through the same IV site as a free-flowing IV.

On the other hand, hydration services can be reported if the hydration is administered before or after a therapeutic or prophylactic drug infusion and chemotherapeutic service. It is very important that there is clear supporting documentation from the provider showing medical necessity for the hydration. Signs and symptoms such as dehydration or nausea with vomiting needs to be documented for proper reporting of a hydration procedure.

Reference: Coding Clinic for HCPCS First Quarter 2012 pages 1-4: IV push, infusion vs hydration
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