ED Coding and Reimbursement Alert

Also, use new codes for hydration this year

If you-re reporting injections and infusions the same way you did in 2005, you-re really behind the times--and setting yourself up for a whopping stack of denials. One of the biggest changes to CPT 2006 is the overhaul of the infusion and injection code sets. However, if you use the new code sets for these procedures, your coding will be more specific, and in line with what payers are looking for.

Read on for the lowdown on the changes for--and how to accurately report--injection and infusion procedures this year.

Use 90765 for the First Hour of Infusion

When reporting infusions, you should scrap last year's code set, 90780 (Intravenous infusion for therapy ...) and +90781 (... each additional hour), said Michael Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED billing company in Stoneham, Mass., during a recent Coding Institute teleconference. On your infusion claims, you should choose from the following codes:

- 90765--Intravenous infusion, for therapy, prophylaxis or diagnosis (specify substance or drug); initial, up to 1 hour

- +90766--... each additional hour, up to 8 hours (list separately in addition to code for primary procedure)

- +90767--... additional sequential infusion, up to 1 hour (list separately in addition to code for primary procedure)

- +90768--- concurrent infusion (list separately in addition to code for primary procedure).

Explore This Expert Example

You must note on the chart that the physician directly supervised the session. Consider this physician supervision example, courtesy of Granovsky:

Coding scenario: A patient with a known seizure disorder arrives by EMS and is postictal after suffering a seizure. The ED physician checks the patient's Dilantin level, which is zero. The patient then suffers a second brief seizure, which the physician treats with Ativan.

The physician then orders an infusion of a gram of Dilantin to prevent further seizures. The physician is immediately available for any issues and in constant communication regarding the patient's status while supervising the nursing staff. The entire session takes 50 minutes.

When reporting infusion services, you would use 90765 for the infusion of Dilantin. On your claim, don't forget to include a description of the physician's actions during the infusion session.

For Injections, Choose From Quintet of New Codes

Injection reporting is also different this year. According to CPT, the following codes are not valid as of Jan. 1:

- 90782--Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular

- 90783--... intra-arterial

- 90784--- intravenous

- 90788--Intramuscular injection of antibiotic (specify)

- 90799--Unlisted therapeutic, prophylactic or diagnostic injection.

On your injection claims, you should choose from these codes instead:

- 90772--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

- 90773--... intra-arterial

- 90774--... intravenous push, single or initial substance/drug

- +90775--... each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure)

- 90779--Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion.

Remember that any intravenous or intra-arterial push sessions require a healthcare provider's continuous presence to observe the patient, Granovsky said. 
 
Watch for: Also, keep in mind that you should choose a code from this set for any infusion that lasts 15 minutes or less.

Add New Hydration Codes

Hydration coding will also be different from now on. In previous years, you would report hydration with the infusion codes 90780 and 90781. But now, hydration procedures have their own code set, says Kevin Arnold, CPC, a coding instructor with Health Information Services Outpatient Coding in Danbury, Conn.

On your hydration claims, report 90760 (Intravenous infusion, hydration; initial, up to one hour) for the first hour of hydration and +90761 (... each additional hour, up to 8 hours [list separately in addition to code for primary procedure]) for each additional hour.

Example: The ED physician sees a 3-year-old with vomiting and diarrhea. During the encounter, the physician discusses IV fluid rehydration with the parents. The physician establishes an IV and administers a normal saline (NS) solution bolus of 20 ml/kg.

The physician re-evaluates the child and orders a second bolus, after which the child is able to take oral fluids. The physician documents a second assessment, and is immediately available for any problems during the hydration process. The total hydration time is 50 minutes.

To report this NS infusion, you would use 90760, since it involves a hydration process.

Observe These Bundles When Coding

If you are reporting an injection/infusion/hydration session, Arnold advises against coding for any of the following materials/services, since they are considered part of any injection/infusion/hydration service:

- Use of local anesthesia
- IV start
- Access to indwelling IV, subcutaneous catheter or port
- Flush at conclusion of infusion
- Standard tubing, syringes, and supplies.

Remember: During most injection or infusion sessions, the ED physician performs a separate evaluation and management service as well. For information on securing separate E/M payment during an injection or infusion session, see -Here's How to Capture Separate E/M With Injections, Infusions- later in this issue.