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Last week RAC Region C contractor Connolly Healthcare posted an automated review for outpatient hospital providers incorrectly billing of Hydration Therapy. Per the issue description, providers are billing Hydration Therapy with diagnosis codes that are not considered reasonable and medically necessary per applicable Local Coverage Determinations (LCDs). Novitas’ Hydration Therapy LCD #L32738 lists specific ICD and CPT combinations:

Medicare is establishing the following limited coverage for CPT/HCPCS codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070 and J7120:

Covered for:

250.80

275.42

276.0

276.50

276.51

276.52

458.9

535.00 – 535.01

535.10 – 535.11

535.20 – 535.21

535.30 – 535.31

535.40 – 535.41

535.50 – 535.51

535.60 – 535.61

535.70 – 535.71

536.2

558.9

578.0

643.10

643.13

643.20

643.23

643.80

643.83

780.2

780.4

780.97

787.01

787.03

787.91

V58.11

Report an encounter for radio-contrast dye(s), when hydration is needed in conjunction with angiography and/or CT scan with contrast, with the primary diagnosis of V15.89 (other specified personal history presenting hazards to health) and one of the secondary diagnoses from the list below. 

Medicare is establishing the following limited coverage for CPT/HCPCS codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070 and J7120:

Covered for:

585.3

585.4

585.5

RAC Issues for the Week of March 10 – March 14, 2014:

No new issues were posted on contractors’ websites.

About the Author

Dr. Margaret Klasa is the medical director for Context4 Healthcare. She is responsible for the company’s business knowledge discovery unit for medical context as it relates to the daily development of data products and software for medical claims editing and coding, with an emphasis on clinical and regulatory guidelines for Medicare, Medicaid and commercial payers.

Contact the Author

Margaret.Klasa@context4.com

To comment on this article please go to editor@racmonitor.com

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