Pediatric Coding Alert

Question: What is the best way to code the time the pediatrician or nurse spends for oral rehydration therapy (ORT)?

North Carolina Subscriber

Answer: No CPT code exists for ORT. You should include the time the pediatrician or nurse spends giving the child the special drink made with oral rehydration salts in the E/M service.

Prior to having the child drink the glucose and sodium solution, the pediatrician performs a history, evaluation and medical decision-making regarding the child's acute diarrhea (787.91) and subsequent dehydration (276.5, Volume depletion). You should code the appropriate-level office visit, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ... physicians typically spend 15 minutes face-to-face with the patient and/or family), based on the pediatrician's documentation.

If the pediatrician provides more than 30 minutes of additional face-to-face contact beyond the time the E/M service contains, you could also bill prolonged services (+99354, Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]; or +99355, ... each additional 30 minutes [list separately in addition to code for prolonged physician service]). For instance, you could report 99213 (15 minutes), 99354 (30-75 minutes) for 45-89 minutes of face-to-face pediatrician-patient contact.

-- Answers to You Be the Coder and Reader Questions provided by Jaime Darling, CPC, certified coder for Graybill Medical Group, which has four pediatricians, in Escondido, Calif.; Jeffrey Linzer Sr., MD, MICP, FAAP, EMS coordinator for the emergency pediatric group at Children's Healthcare of Atlanta at Egleston; and Richard H. Tuck, MD, FAAP, a pediatrician in Zanesville, Ohio.