ED Coding and Reimbursement Alert

Question: A patient who is complaining of diarrhea and extreme thirst reports to the ED. Suspecting dehydration, the physician places an IV and conducts normal saline hydration for 1 hour and 45 minutes. Notes also seem to indicate a separate evaluation and management service. Can we report the E/M too, or is it bundled into the hydration code?


Maryland Subscriber


Answer: Yes, you can report the E/M service along with the hydration codes. An encounter for hydration (or injections) typically includes a separate (E/M) service that CPT allows you to code separately.
 
Hydration coding: For the hydration service, you should:
 
- report 90760 (Intravenous infusion, hydration; initial, up to one hour) for the first hour of hydration.

- report +90761 (... each additional hour [list separately in addition to code for primary procedure]) for the remaining 45 minutes of hydration.

- link 787.91 (Diarrhea) to 90760 and 90761 to represent the patient's diarrhea.

- link 783.5 (Polydipsia) to 90760 and 90761 to represent the patient's thirst.

E/M coding: The E/M code you report will depend on the level of service the physician provides. Typically for presentations of this nature, the patient's problems will call for moderate medical decision-making. This means that most hydration encounters will support a level-three or level-four E/M (and perhaps even higher). Note: Some payers including Medicare will not pay for hydration in the emergency department, so it is best to check on individual payer policy.

Remember: Whatever E/M code you choose for the claim, be sure to link ICD-9 codes 787.91 and 783.5 to it to prove medical necessity. Also, attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code so the payer knows that the E/M and hydration were separate services.