Look at Watch for Infusion Codes
Question: Which codes would apply for a Medicare patient who received the following?
NS L Bolus
Phenergan 12.5 mg IV
Reglan 10 mg IV
Stadol 2mg IV.
Texas Subscriber
Answer: The new injection/ infusion coding rules for 2006 make keeping track of time a crucial task. First, you need to know how long the patient received hydration and for what purpose. If the hydration was more than 16 minutes, it meets the qualification for an infusion. If the bolus ran 15 minutes or less, you should report it as an intravenous (IV) push injection (C8952). However, fluid used to administer drugs is considered incidental hydration, and you shouldn’t report a separate infusion service.
If the hydration ran more than 90 minutes, you need to bill the code for additional hours (C8951). Remember: Base your times on the rule of 31 minutes into the next hour to code each additional hour of infusion. Note that you shouldn’t report C8950 and C8951 when the infusion is a necessary and integral part of a separately payable OPPS procedure.
You’ll have to ask about this particular case, because you cannot determine the time when the record just says “bolus.”
You also need to know if the staff administered any of the injections together. Assuming that all the medications were push injections and not infusions, you would report the following to Medicare: C8952 x 3 for the medicated IV push injections (if they were all given separately).
Note: If any of the injections were given in the same syringe at the same time, you count that as a single injection.
Question: Can I report acute and late effect codes for the same burn injuries?
Alabama Subscriber
Answer: Yes, though you’ll want to check the etiology of the burns. For example, you can have an acute, non-healing, and late effect all in the same area--but in different parts of that area. For example, if you divide the trunk into four parts--the anterior trunk from the neck down to the pubis and side-to-side--it’s certainly possible that the patient may have four different wounds simultaneously. As long as the practitioner can justify the exact stage of each wound, you may be able to use any of those codes (and in combination, if appropriate).
Question: A patient came in for a GI outpatient procedure. While in the OR, the patient began bleeding uncontrollably. The doctor ended up performing esophageal tamponade (43460) and admitted the patient to ICU, thus transferring the patient to a higher level of care.
We have admission orders to the ICU, but the surgical procedure occurred prior to the actual “admission.” Can we still code the inpatient-only procedure even though it was done while the patient was an outpatient? Are there any special modifiers that we need to use?
Ohio Subscriber
Answer: Because you can only submit one bill for the entire visit, the patient’s whole course of treatment in this case necessitates an inpatient rather than an outpatient bill. When you (or the inpatient coders) report these procedures, you’ll code all procedures in the medical record from the time the patient arrived at the hospital.
Whether the physician performed the procedure before or after writing the admit order is actually irrelevant--the time of each action doesn’t show up on the UB-92.
Question: We received an x-ray order without a diagnosis or symptoms listed. Should we return it to the x-ray department, or call the doctor for the necessary information?
Rhode Island Subscriber
Answer: At some facilities, you may be just fine contacting the physician yourself (and that may be the quickest solution). Others prefer that the query for updated written orders come from the staff at the point of service--in this case, the radiology department--because they should have all the appropriate documentation before they perform the procedure.
Remember: The order from radiology should include the type of procedure, the diagnosis, the patient’s name, and the ordering physician’s signature.
Question: What is the difference between the two codes for clearing an obstructive vascular catheter, 36595 and 36596?
Oregon Subscriber
Answer: Code 36595 (Mechanical removal of pericatheter obstructive material [e.g., fibrin sheath] from central venous device via separate venous access) describes removal of pericatheter material through a separate access point.
Code 36596 (Mechanical removal of intraluminal [intracatheter] obstructive material from central venous device through device lumen), on the other hand, de-scribes removal of an intraluminal obstruction. During this procedure, the physician might take a brush and run it down through the catheter to remove the sheath that has accumulated inside the patient’s catheter.
To decide which code you should report, you need to find out whether the obstructive material is inside the catheter or outside of it. If the obstruction is inside, you’ll report 36596. If it’s outside, you’ll use 36595 because the obstruction requires remote access for the physician to remove it.
Reader Questions reviewed by Sarah Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
