ED Coding and Reimbursement Alert

Question: A 92-year-old nursing home patient arrived at the ED via ambulance showing symptoms such as dizziness and confusion; the emergency medical technician said that the patient had been complaining of extreme thirst. During the examination, the physician diagnosed dehydration and conducted a 33-minute intravenous rehydration. Can I report the hydration for this patient? Our billing service said it isn’t billable in the facility setting, so we aren’t sure whether we can report it.

Codify Subscriber

Answer: Your billing service is correct in that physicians cannot report 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) or +96361 (... each additional hour [List separately in addition to code for primary procedure]) in a facility setting. Although the ED is considered an outpatient setting, it’s an outpatient facility setting.

CPT^® is clear on this point as well, noting, “Codes 96360-96379, 96401, 96402, 96409-96425, 96521-96523 are not intended to be reported by the physician in the facility setting.” The rationale is that hospital staff are actually doing these procedures and they are covered on the facility side payment.