CODING CORNER: Avoid ED Coding Budget-Breakers With These Tips

Save big bucks by knowing guideline details

The emergency department is one of the biggest money-drainers in most facilities - and incorrectly coding claims is often at the root of the problem.
Proper reporting of infusions and injections, observation services, and evaluation and management codes will help plug up your reimbursement leaks, so check out these strategies to streamline the process.
Identify Infusion Do's and Don'ts
The rules for reporting infusions changed considerably in 2005, but many coders are still floundering with whether and when they can report infusions. Use these guidelines to decide:


Do report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) only once per visit per diagnosis, no matter how many bags of fluid the nurse used. You can, however, code infusion therapy separately during visits for separate problems.


Don't use an infusion code for chemotherapeutic drugs. For nonchemo infusions, you'll report 90780. For chemotherapeutic infusions, you should choose a code from the following:

  96410 - Chemotherapy administration, intravenous; infusion technique, up to one
 hour

  +96412 - ... infusion technique, one to eight hours, each additional hour (list separately in addition to code for primary procedure)

  96414 - ...infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump

  96422 - Chemotherapy administration, intra-arterial; infusion technique, up to one hour

  +96423 - ...infusion technique, one to eight hours, each additional hour (list separately in addition to code for primary procedure)

  96425 - ...infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump.


Do report intravenous (IV push) injections into an infusion line separately from other infusions and procedures - they're separate procedures.


Don't bill for infusion used to keep a vein open (discrete infusion), to flush a line, or to keep a line open between units of blood.


Do make sure the infusion is medically necessary (for example, for dehydration) and supported by documentation.


Don't separately report peripheral insertion of an IV for transfusion of blood or blood products.


Do separately report infusions performed on the same day during separate ED visits using modifier 59 (Distinct procedural service). With modifier 59 appended to 90780 or 90781, the outpatient code editor (OCE) will allow you to bill up to four units of APC 120 - and get paid, says Caral Edelberg, CPC, CCS-P, president of Medical Management Resources Inc. and member of theAmerican Academy of Professional Coders (AAPC) advisory board, who presented on ED coding for facilities at the 13th annual AAPC conference.

Important: Make sure you're not still using the Q codes to report infusion [...]

- Published on 2005-07-20