Pediatric Coding Alert

Question: A pediatrician at our urgent care center ordered intravenous (IV) hydration for a pediatric patient who had diarrhea. The infusion lasted 20 minutes. May I report 90760?

California Subscriber

You may report the hydration with 90760 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) if the claim is in 2007. CPT 2008 adds two criteria to the hydration codes. Your scenario fails to meet either of these requirements:

1. Place of service (POS): When coding for the physician, the service must not occur in a facility. CPT 2008 hydration, therapeutic, prophylactic, and diagnostic injections and infusions (excluding chemotherapy) introductory notes stipulate, "These codes are not intended to be reported by the physician in the facility setting." Because an urgent care center is classified as a facility (POS 20, Urgent care facility), you should not report hydration services for the physician in such a setting. You can, however, still report 90780-90781 in the office setting (POS 11)

2. Time: The hydration must last 31 minutes or more. The AMA revised 90760's descriptor for 2008 to "31 minutes to 1 hour" from "up to 1 hour." "Do not report intravenous infusion for hydration of 30 months or less," according to an added parenthetical CPT instruction following +90761 (... each additional hour [list separately in addition to code for primary procedure]).

Don't miss: You can still report the pediatrician's E/M service for the diarrhea that led to the hydration with the appropriate level office visit code (99201-99215, Office or other outpatient services). For the ICD-9 code, use the diarrhea diagnosis, such as 787.91, which includes acute diarrhea. Also report the dehydration (276.51). Coding the disorder could support a higher level of E/M service than coding the symptom alone.

Exception: If you were coding a diarrhea E/M that led to 31 minutes or more of hydration treatment in the office, you would instead link the office visit (99201-99215) to the diarrhea symptom (787.91) and the hydration (90780-90781) to the dehydration disorder (276.51). Although CPT does not require separate diagnoses, using distinct diagnoses will help the insurer see the individual nature of the service and the treatment. In addition, payers may require modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on 99201-99215. CPT, however, does not require you to use modifier 25 on claims involving an E/M and hydration.