ED Coding and Reimbursement Alert

Question: What guidelines govern reporting a patient who receives less than two full hours of intravenous infusion in the ED? In other words, should we bill CPT 90780 for the first hour and 90781 for the second hour? Should we round up or down if the time is more than or less than 30 minutes, and add modifier -52?

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Answer: The CPT book does not specifically address this question with thresholds for minimum time requirements to report these services, as it does for critical care services. However, CPT Assistant states, "In the instance when an infusion lasts over one hour, but less than a full additional hour, modifier -52 (Reduced services) should be appended to code 90781 to indicate that the time beyond the first hour was less than an hour."    
  
For example, if the total duration of infusion is one and a half hours, you should report code 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for the first hour of administration. For the additional half hour, you'll report +90781-52 (... each additional hour, up to eight hours; reduced services).   
 
Remember: These codes require the physician to perform or directly supervise the service, so make sure it's medically necessary for him to do so.

- Reader Questions and You Be The Coder reviewed by Michael Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems in Stoneham, Mass.