Pediatric Coding Alert

Replace hydration therapy's '8' with a '6'

You can seamlessly transition to the new infusion therapy coding method without confronting a denial--if you know these four rules.

CPT Codes 2006 replaces its universal infusion codes with six new codes. “You should assign the new CPT codes based on the infused substance--non-medicine (90760-90761) or medicine (90765-90768),” says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J. Instead of using a single code set (90780-90781), CPT breaks intravenous therapy into two areas:

1. 90760-90761 for hydration

2. 90765-90768 for therapy, prophylactic and diagnostic administration.

Use 90760-90761 for Saline Solutions

To avoid invalid-code denials in 2006, you should report hydration IV infusion with two time-based CPT codes. “Use 90760-90761 for IV infusion of saline and glucose-saline solutions,” Scott says. In these cases, staff members administer a prepackaged fluid and electrolyte solution to hydrate the patient. Caveat: These codes require direct physician supervision, which means the pediatrician must be in the office or the hospital, but not necessarily in the exam room or bedside, throughout the procedure.

The therapy’s time further determines the correct hydration therapy code(s). If the service is greater than 15 minutes, you should report the first hour of hydration infusion with 90760 (Intravenous infusion, hydration; initial, up to one hour). If the pediatrician directly supervises the therapy for an additional 30 minutes, you should also report +90761 (... each additional hour, up to 8 hours [list separately in addition to code for primary procedure]).

Important: Base hydration time only on the infusion’s administration time. “Services leading up to and concluding the infusion have been included in the infusion service code and are not separately reported,” states the AMA in CPT Changes 2006: An Insider’s View. The codes also include line placement and supplies. But you may report a significant and separate E/M service with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

Old method: In 2005, you should have coded hydration therapy with a general CPT infusion code. The applicable codes would have been 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 eight [8] hours [list separately in addition to code for primary procedure]). 
 
Do this in 2006: A pediatrician directly supervises an IV infusion of 500 ccs of normal saline solution to a patient with diarrhea and vomiting. Documentation states the infusion administration occurs from 2:20-3 p.m. Because the IV infusion lasts less than one hour, you should report the service with 90760. On 2005 claims, you would have assigned 90780.

Report Drug Infusion With 90765-90768

Make sure you avoid hydration therapy codes when staff uses an IV to administer something other than pre-packaged fluid and/or electrolyte solutions. Opt instead for therapeutic, prophylactic and diagnostic infusion codes (90765-90768) when they “put medication in an IV bag,” says Patricia Davis, CPC, business office supervisor at Middlesex Health System Primary Care, which serves 12 pediatricians in Middletown, Conn.

The new codes allow you to bill for how you’re providing drugs or other substances. “They represent drug infusion, just like 90772 represents drug injection,” Davis says.

When the infusion involves administering a single drug, choosing the correct therapeutic, prophylactic or diagnostic infusion is relatively simple. “You should assign 90765-90766 based on the infusion’s duration,” Davis says. If the pediatrician directly supervises an infusion that lasts less than one hour, report 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to one hour). For infusions lasting longer than one hour, also use +90766 (… each additional hour, up to 8 hours [list separately in addition to code for primary procedure]).

Example: A pediatrician directly supervises IV infusion of Rocephin for a child with pneumonia. The IV infusion administration lasts 30 minutes. Because the infusion involves a drug, you should code a therapeutic, prophylactic or diagnostic infusion, rather than hydration therapy, Scott says. Because this infusion takes 30 minutes and involves one substance, you should report the therapy as 90765 with 486 (Pneumonia, organism unspecified). For the medication, bill J0696 (Injection, ceftriaxone sodium, per 250 mg), if the office supplies  the drug.

Capture 91st, 151st Minutes Using 90761/90766

Although unusual in the office when coding longer infusions that may occur in the observation or hospital setting, don’t limit yourself to claiming 90761 and 90766 only once. You should use 90761 for each additional hour of infusion, says Kathy Pride, CPC, CCS-P, a coding training manager for QuadraMed’s Government Programs Division in Port St. Lucie, Fla. “That means you can report 90761 and 90766 with multiple units based on the number of additional hours of infusion.”

Tip: You don’t have to wait until an infusion lasts for two hours to assign 90761/90766 or for three hours to use a “2” in the units field. CPT’s parenthetical note following 90761 states, “Report 90761 for hydration infusion intervals of greater than 30 minutes beyond 1-hour increments.” A similar note appears after 90766. “Report 90766 for infusion intervals of greater than 30 minutes beyond 1-hour increments,” the CPT manual states.

Action: “You can bill an additional unit when the service goes more than 30 minutes into the next hour,” Pride says. So you can start assigning 90761/90766 at 91 minutes and 90761/90766 with “2” units at minute 151. 

Identify Multiple Substances’ Status

Also uncommon in the office setting, you may deal with encounters involving administration of multiple drugs in the hospital or observation setting. In these cases, take this extra step for infusions involving more than one drug. Identify the substance’s status by determining whether the drug administered is:

Initial: For infusion of the initial or main substance, report 90765, 90766.

Sequential: When a pediatrician administers a second drug during an hour-long infusion therapy, also report code +90767, … additional sequential infusion, up to one hour (list separately in addition to code for primary procedure).

Concurrent: When a staff member provides two IV drugs to a patient at the same time, you should additionally assign +90768, … concurrent infusion (list separately in addition to code for primary procedure).