ED Coding and Reimbursement Alert

Question: A patient presents with an allergic reaction that resulted in throat swelling, pain and difficulty swallowing, along with wheezing. The doctor ordered an infusion session using Solu-Medrol. The entire infusion procedure took 95 minutes. How should I report this visit?

Oklahoma Subscriber
 
Answer: Report 787.2 (Dysphagia; Difficulty in swallowing) and 786.07 (Wheezing) for the throat swelling and trouble breathing The Solu-Medrol session lasted more than an hour, and that must be reflected in the coding, so report 90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and  +90781 (... each additional hour, up to [8] hours [list separately in addition to code for primary procedure]).
 
For maximum reimbursement, document time down to the minute. Due to the nature of an emergency department (and the fact that procedures with time-based codes are rarely performed in an ED), many ED doctors don't track time exactly for every procedure. If you want to be paid fully for this type of session, though, the physician must clearly account for infusion time.