ED Coding and Reimbursement Alert

Question: A patient undergoing chemotherapy for tracheal cancer reports to the ED suffering from dehydration. Under physician supervision, a nurse hydrates the patient with 250 cc of normal saline for 40 minutes. How do I report this encounter?

Georgia Subscriber

Answer: To report this encounter correctly, you-ll need to follow rules that providers outside of the ED won't have to.

Explanation: ED physicians can no longer report the hydration code 90760 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour).

According to CPT 2008, "Physician work related to hydration, injection and infusion services predominately involves affirmation of treatment plan and direct supervision of staff. These codes are not intended to be reported by the physician in the facility setting."

These rules, however, do not apply to the facility side of the ED, only physicians.

Result: You-ll have to choose the appropriate level E/M code for your hydration services, such as 99283. So if the encounter notes indicate a level-three E/M, you should report the following:

- 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of moderate complexity) for the E/M

- 276.51 (Dehydration) appended to 99283 to represent the patient's dehydration

- 162.0 (Malignant neoplasm of trachea, bronchus and lung; trachea) appended to 99283 to represent the patient's underlying condition.

Forget these, too: In addition to 90760, CPT 2008 also forbids ED physicians from reporting the following codes in the ED setting:

- +90761  (- each additional hour [list separately in addition to primary procedure]) through +90776 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of the same substance/drug provided in a facility [list separately in addition to code for primary procedure]).

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.