Raise Your Payment for Hormone Stimulation Tests

Simple coding and documentation mistakes can cost you $57 per visit

Choosing the right codes for hormone stimulation tests is extremely complicated. You can select the right codes for these tests every time by developing a special procedure sheet to document all services and drugs during a test.
 
Hormone stimulation is a diagnostic test that endocrinologists perform in the office or in an outpatient hospital setting. The patient needs observation the entire time, and the test can last from 30 minutes to several hours. Depending on which hormone stimulation test the endocrinologist orders, the patient will receive an infusion or injection, as well as several blood draws.
Choose the Proper Infusion or Injection Code First
If the test involves an infusion and the endocrinologist provides direct supervision, you should use 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour). The key to avoiding denials on this code is having documentation that your physician either administered the drug or provided "direct supervision" over the staff member who did.

But "direct supervision" doesn't mean that Medicare requires the physician's presence in the room. Instead, you can bill for 90780 under the "incident-to" billing guidelines when a nonphysician practitioner performs the infusion. The physician must be present in the office suite and immediately available to provide assistance and direction, according to the Medicare Carriers Manual (MCM), section 2050.1.

Here's an example: A 13-year-old male is referred to the endocrinologist for evaluation of his short stature and delayed puberty. The endocrinologist orders a growth hormone stimulation test. On the day of the test, the physician is present in the office and checks in on the patient intermittently. He documents that the test lasted a little over two hours. You report +90780 for the infusion and 90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) for the extra time the physician spent with the patient. And, you need to bill for the drugs used by reporting J codes such as J1642 (Injection, heparin sodium [heparin lock flush], per 10 units), J2912 (Injection, sodium chloride, 0.9%, per 2 ml), and J1620 (Injection, gonadorelin HCl [Factrel], per 100 mcg), says Kathy Pride, a consultant with QuadraMed in Port Saint Lucie, Fla.

If an RN administers the test without the physician's supervision or there isn't adequate documentation of the physician's supervision, you cannot report 90780. In that case, you would use 36000 (Introduction of needle or intracatheter, vein) along with the appropriate J codes.

Payoff: In 2004, Medicare pays $90 for 90780 -- that's more than twice as much as last year when the code brought only $42, according to [...]

- Published on 2004-03-12