# Help with iv's



## justcode (Nov 5, 2012)

Hello. Im new at charge coding for er and i need help.

Pt came in to er with
final dx:


Acute vomiting
acute dehydration

pt was given:

Sodium chloride iv
    start:2110     stop:2142

zofran 4mg/2ml inj   iv
     start: 2110    stop: 2111
zofran 4mg/2ml inj   iv
     start: 2317     stop: ?

I was told to code it as 96374, 96376, 96361.  Is this correct?


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## salCCS (Nov 6, 2012)

the codes are correct


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## justcode (Nov 7, 2012)

thanks sal.  but i have one more question.  why do i have to code 96361 when the sodium chloride and the zofran started at 2110. since zofran is a push and it was given at the same time as the sodium chloride doesnt that cancel the sodium chloride?

i hope i'm not confusing you..coz i am 

Thanks again for taking the time to reply..


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## salCCS (Nov 9, 2012)

I see what you are saying. 

if patient had an IV just to keep line open then I wouldnt code 96361 
your patient had

vomiting & dehydration 
zofran for vomiting and hydration for dehydration. 

this is how I see it. i would like to see what others think.


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## salCCS (Nov 12, 2012)

I confirmed with my boss and she agrees with me. Codes are correct as posted


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## mitchellde (Nov 13, 2012)

the IV Push does negate the IV hydration but the IV push stopped at 2111 and the IV sodium cloride ran uninterruped from 2111 to 2142 which is 31 minutes so you meet the criteria to bill the hydration, 
I hope that is of assistance to you


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## Naveen Rachagolla (Nov 15, 2012)

justcode said:


> Hello. Im new at charge coding for er and i need help.
> 
> Pt came in to er with
> final dx:
> ...



I guess it should be 96360 instead of 96361, beause the sodium chloride IV is for 32 minutes which is below 1 hour so the correct code is 96360. 96361 is for each additional hour and more over itis a add-on code and cannot be billed as stand alone code.


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## justcode (Nov 15, 2012)

@naveen..no you can't code 96360 because you can't have 2 initials

anyone else have a take on this?


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## salCCS (Nov 15, 2012)

if at the same site you cannot have two initials. i attached article that might help you understand a little more 


For example, if you have hydration and an IV push, you would code the IV push (96374) as the initial service and report add-on code 96361 to report the hydration. You may believe you need to report 96360 before you can report 96361, but that is not the case with drug administration add-on codes. The exact codes will depend on the specific situation.

When multiple infusions are provided at the same time though the same IV line, look to the concurrent codes. Read the documentation to determine how many different sites are being accessed. Don't focus on the number of drugs being infused or the number of different bags being hung—it's the number of access sites that matter.

Don't let the use of multi-lumen catheters fool you because they still use a single access site. This is why you have to look at how many different access sites to determine whether you can report multiple initial service codes. If drugs are administered through the same site, you would report the concurrent infusion code.

However, if a patient has an IV started in each arm, it would be considered two access sites. Report an initial service for each site and each subsequent service based on what the providers documented and actually administered through each specific site, Rinkle says. Append modifier -59 (distinct procedural service) to those codes for the second site.


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