ED Coding and Reimbursement Alert

Question:  A patient reports to the ED reporting dehydration, weakness, and flu-like symptoms. The ED physician performs an E/M service, during which patient receives rehydration service, along with an H1N1 vaccination. Final diagnosis is dehydration.  How many CPT® codes should I report for this service?

Illinois Subscriber

Answer:  You’ll only be able to submit a single CPT® code for this service. Though there are codes for hydration and H1N1 vaccination, these services, or any other hydration, injection and infusion (HII) services can be billed only by the facility, not the ED physician. 

In this case, you are probably looking at a higher level ED E/M code to capture the work the physician performs during rehydration and vaccination, depending on the chart documentation. Be sure to submit the following diagnosis codes to represent the encounter:

276.51 (Volume depletion; dehydration) for the dehydration
V04.81 (Need for prophylactic vaccination and inoculation against certain diseases; influenza) to represent the H1N1 administration ICD-10 codes
E86.0 (Dehydration)
Z23 (Encounter for immunization)